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Chemo may raise false hopes in cancer patients

Sunday October 28, 2012
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Patients with advanced lung or colorectal cancer frequently are mistaken in their beliefs that chemotherapy can cure their disease, according to a study.

Researchers with the Dana-Farber Cancer Institute found that 69% of patients with advanced lung cancer and 81% of patients with advanced colorectal cancer did not understand that the chemotherapy they were receiving was unlikely to cure their disease. Their expectations run counter to the fact that although chemotherapy can alleviate pain and extend life in such patients by weeks or months, it is not a cure for these types of advanced cancer except in the rarest of circumstances.

The study, which appears in the Oct. 25 issue of the New England Journal of Medicine, was conducted by surveying 1,274 patients at hospitals, clinics and treatment centers across the country and by undertaking a comprehensive review of their records. Study participants had been diagnosed with metastatic lung or colorectal cancer at least four months earlier and had received chemotherapy for their disease.

Although previous studies had polled cancer patients about their perceptions of chemotherapy, this study was the first to involve such a large and varied cross-section of the population, the researchers said.

The researchers found inaccurate expectations about the role of chemotherapy among patients from varied backgrounds treated in many different healthcare settings across the U.S.

"If patients do not know whether a treatment offers a realistic possibility of cure, their ability to make informed treatment decisions that are consistent with their preferences may be compromised," Jane Weeks, MD, MSc, the study’s lead author, said in a news release. "This misunderstanding may pose obstacles to optimal end-of-life planning."

Surprisingly, patients who rated their communication with their physician highly were the most likely to hold overoptimistic views about chemotherapy’s curative potential.

Although communication about prognosis in advanced cancer is challenging, a sizeable minority of study participants did grasp the incurable nature of their cancers. "Skilled clinicians can set realistic expectations without their patients’ losing either hope or trust," said study co-author Deborah Schrag, MD, MPH. However, further research will be necessary to identify strategies to help physicians more consistently set realistic expectations and thereby help patients make good decisions about their care.

The findings come from the Cancer Care Outcomes Research and Surveillance Consortium, a large nationwide study sponsored by the National Cancer Institute to understand many facets of cancer care in the United States. Weeks is the CanCORS Consortium’s scientific chair and is director of the McGraw/Patterson Center for Population Sciences at Dana-Farber, professor of medicine at Harvard Medical School and professor of health policy and management at Harvard School of Public Health.

The study appears in the Oct. 25 issue of the New England Journal of Medicine. The study abstract is available at www.nejm.org/doi/full/10.1056/NEJMoa1204410.


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