Improved doctor-patient communication is needed to set realistic treatment expectations
PDF of press release and abstract
Incurable lung cancer patients often experience severe pain or other symptoms due to their cancer and are prescribed palliative radiation therapy (RT) to improve quality of life. Unfortunately, many of these patients mistakenly believe that RT administered for palliative care may cure their disease, according to research presented today at the American Society for Radiation Oncology’s (ASTRO’s) 54th Annual Meeting.
The study investigated patient beliefs about the effectiveness of palliative RT and analyzed survey data from 384 patients over the age of 21 who were diagnosed with stage IIIB (wet) or IV lung cancer from 2003 to 2005. Patients in the study received or were scheduled to receive RT and completed a survey approximately four months after diagnosis. Results from the survey indicated that most patients believed that palliative RT could help them: 78 percent of patients believed that RT was “very” or “somewhat likely” to help them live longer, and 67 percent believed that RT was “very” or “somewhat likely” to help them with problems or symptoms resulting from their cancer. Of concern, however, 64 percent did not understand that RT was not at all likely to cure their disease.
Patients with metastatic lung cancer survive less than one year, on average, and fewer than five percent survive five years. While not all patients are open to hearing or accepting prognostic information, the study’s results suggest that it is important for patients to have a better understanding of their cancer and various treatment options and goals to guide them as they make decisions. Study authors are concerned that if patients are overly optimistic about their chances of cure from palliative radiation therapy, it could lead them to seek more intensive and lengthier treatments, which could be costly and decrease their quality of life.
Data for the survey was compiled using the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, a population- and health system-based prospective cohort study, which collected data on more than 5,000 newly diagnosed lung cancer patients in five geographic regions, 10 Veterans Administration sites and five large health maintenance organizations. Patient/surrogate responses were evaluated to the question: “After talking with your doctors about radiation therapy, how likely did you think it was that radiation would…” with the answer categories of “help you live longer,” “help with problems from cancer,” and “cure your cancer.” Responses were graded in categories ranging from “not at all likely” to “very likely.”
“Our study found that, though most lung cancer patients are optimistic about the effectiveness of radiation therapy in relieving symptoms and prolonging life, many have inaccurate beliefs about the ability of palliative RT to cure their cancer,” said Aileen B. Chen, MD, MPP, lead author of the study and a radiation oncologist at Dana-Farber Cancer Institute in Boston. “In order to help patients make informed decisions about radiation treatments near the end of life, health care providers need to improve communication and understanding about the goals and limitations of palliative RT. While palliative RT can be very effective at relieving symptoms from cancer, overly intensive care can also reduce patients’ quality of life and lead to significant time and financial burdens for patients and their families.”
Indeed, recent studies show similar challenges in communicating information about poor prognosis to patients exist among medical oncologists, as well as doctors who care for the terminally ill. While some doctors are hesitant to share or discuss poor prognosis with patients due to feelings of empathy, it is important for physicians to be educated about this process―data suggest that these discussions do not take away hope but empower patients to make decisions that are right for them.
The abstract, “Patient Beliefs About Palliative Radiation Therapy (RT) in Incurable Lung Cancer,” will be presented in detail during the plenary session at ASTRO’s 54th Annual Meeting at 2:30 p.m. Eastern time on Monday, October 29, 2012. To speak with Dr. Chen, email or call Michelle Kirkwood on October 28 – 31, 2012, in the ASTRO Press Office at the Boston Convention and Exhibition Center at 617-954-3461 or 617-954-3462.
ASTRO’s 54th Annual Meeting, held in Boston, October 28 – 31, 2012, is the premier scientific meeting in radiation oncology and brings together more than 11,000 attendees including oncologists from all disciplines, medical physicists, dosimetrists, radiation therapists, radiation oncology nurses and nurse practitioners, biologists, physician assistants, practice administrators, industry representatives and other health care professionals from around the world. The theme of the 2012 Annual Meeting is “Advancing Patient Care through Innovation” and examines how innovation in technology and patient care delivery can lead to improved patient outcomes. The four-day scientific meeting includes six plenary papers and 410 oral presentations in 63 oral scientific sessions, and 1,724 posters and 130 digital posters in 18 tracks/topic areas.