Majority of patients with newly diagnosed metastatic cancer think that chemotherapy may be curative, surveys suggest

A majority of patients with newly diagnosed metastatic lung and colorectal cancer undergoing chemotherapy believe the treatment might be curative, a study found, although more realistic expectations were associated with patients treated in an integrated network.

Researchers applied data from the national Cancer Care Outcomes Research and Surveillance study to find out whether and why patients with metastatic disease thought chemotherapy might be curative in intent. Professional interviewers surveyed about 10,000 patients with newly diagnosed stage IV lung or colorectal cancer nationwide from four to seven months after diagnosis.

Results appeared in the Oct. 25 New England Journal of Medicine.

Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer who completed the survey responded that they thought chemotherapy might be curative.

Patients who reported higher scores for physician communication were less likely to provide accurate responses. A score of 80 to 99 resulted in less likelihood of an accurate response compared to a score of less than 80 (OR, 1.37; 95% CI, 0.93 to 2.02) and a perfect communication score of 100 resulted in less likelihood compared to a score of less than 80 (OR, 1.90; 95% CI, 1.33 to 2.72; P=0.002 for the overall comparison).

Education, functional status and the patient's role in decision making were not significantly associated with the belief in curative potential.

“The observed association between inaccurate beliefs about the likelihood of cure and higher ratings of physician communication suggests a link between physicians' communication behaviors and patients' understanding of treatment benefits,” researchers wrote. “This suggests that patients perceive physicians as better communicators when they convey a more optimistic view of chemotherapy. Similarly, the finding that patients, especially those with colorectal cancer, who were treated in integrated networks were somewhat more likely to understand that chemotherapy is not curative suggests that providers may be able to improve patients' understanding if they feel it is part of their professional role.”

An editorial commented that the disconnect is likely a result of several factors, from doctors having trouble with delivering news of a terminal diagnosis to patients not believing it.

“This is not one hard conversation for which we can muster our courage but a series of conversations over time from the first existential threat to life,” the editorial stated. “We recommend stating the prognosis at the first visit, appointing someone in the office to ensure there is a discussion of advance directives, helping to schedule a hospice-information visit within the first three visits, and offering to discuss prognosis and coping (“What is important to you?”) at each transition.”