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NLM Director’s Comments Transcript
False Chemotherapy Expectations and Improving Patient Communication: 11/26/2012

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what's new this week in MedlinePlus.listen

Most patients who received chemotherapy for newly diagnosed, advanced lung cancer and colorectal cancer did not understand that the drug therapy is an unlikely cancer cure, finds an insightful study recently published in the New England Journal of Medicine.

Specifically, the study found 61 percent of patients with advanced lung cancer and 81 percent of patients with advanced colorectal cancer failed to understand chemotherapy’s limitations.

The study of about 1,200 adults suggests there is significant patient misunderstanding about chemotherapy’s curative potential, which the authors add undermines a physician’s ability to help a patient manage his or her treatment options. The authors explain chemotherapy for stage 4, or metastatic lung or colorectal cancer, (and we quote) ‘may prolong life by weeks or months and may provide palliation, but it is not curative’ (end of quote).

In a distinctive focus, the study’s seven authors assessed the prevalence of inaccurate patient expectations about chemotherapy. The 1,200 patients were participants in the Cancer Care Outcomes Research and Surveillance study, a broader, national study partially sponsored by the National Cancer Institute. The study’s findings were based on clinical records and patient interviews.

The study found the risk adults would report inaccurate beliefs about chemotherapy’s curative potential was significantly higher among participants with colorectal compared to lung cancer. Similarly, the risk to report inaccurate beliefs about chemotherapy’s curative potential was significantly higher comparing nonwhite and Hispanic to non-Hispanic white and African-American patients.

In addition, the risk that patients reported inaccurate beliefs about chemotherapy’s curative potential was comparatively higher among patients who rated communication with their physician more favorably.

Yet, the study found a participant’s educational level, their functional status, and perceived role in making treatment decisions were not associated with an elevated risk to report inaccurate beliefs about chemotherapy’s curative potential.

While the authors explain previous research strongly suggests most oncologists (cancer specialists) inform patients when cancer is not curable, the authors write (and we quote): ‘it is clear from the results of our study and other studies that disclosure alone may not lead to sustained understanding among patients’ (end of quote).

The physician-authors of an accompanying editorial succinctly add (and we quote): ‘we need help breaking bad news’ (end of quote).

The study’s authors speculate a lack of understanding, or creating false patient optimism, may be a result of conversations when a physician makes a quick transition to discuss chemotherapy options after a stage 4 cancer diagnosis initially is conveyed.

The authors note while there is an extensive literature to help physicians effectively and compassionately engage patients in terminal illness and end–of–life care discussions, there is less written about helping patients recognize that a therapeutic treatment (such as chemotherapy) is not a cure. The authors add more consumer health information websites should clarify chemotherapy’s limitations.

The accompanying editorial explains the misunderstandings revealed in the study’s findings should not be interpreted as examples of patient self–deceit or unrealistic optimism. While the editorial’s authors note some patients may chose not to believe an incurable disease prognosis, the authors add the study’s findings suggest patients and physicians need a new level of assistance to better understand medical treatment options when a medical condition is incurable.

To remedy, the editorial’s authors suggest physicians tell a patient an incurable disease prognosis at the first office visit, appoint someone in the office to ensure there is a discussion about directives and treatment options, schedule a hospice information visit within the first three visits, and then, discuss prognosis and coping in subsequent meetings.

The editorial’s authors conclude (and we quote): ‘If patients are offered truthful information — repeatedly — on what is going to happen to them, they can choose wisely’ (end of quote).

To similarly assist patients, the ‘related issues’ section of MedlinePlus.gov’s talking with your doctor health topic page provides a link a webpage that discusses living with a serious illness. A recommended link that summarizes research about end–of–life discussions between advanced cancer patients and their physician is within the ‘research’ section of MedlinePlus.gov’s talking with your doctor health topic page.

MedlinePlus.gov’s talking with your doctor health topic page also contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Some specific tips to assist seniors are provided within the ‘seniors’ section of MedlinePlus.gov’s talking with your doctor health topic page. From the talking with your doctor health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

An excellent guide to understanding chemotherapy for cancer treatment also is available in the ‘overviews’ section of MedlinePlus.gov’s cancer chemotherapy health topic page.

To find MedlinePlus.gov’s talking with your doctor health topic page, type ‘talking with your doctor’ in the search box at the top of MedlinePlus.gov’s home page. To find MedlinePlus.gov’s cancer chemotherapy health topic page, type ‘cancer chemotherapy’ in the search box on MedlinePlus.gov’s home page. MedlinePlus.gov additionally has health topic pages devoted to lung and colorectal cancer.

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