Patients and Physicians Differ on Chemotherapy Expectations

SAN FRANCISCO—Most cancer patients undergoing chemotherapy expect to be cured, even when cautioned by their physicians that the chemotherapy can only relieve symptoms, according to Geetha N. Varma, MD. Research conducted at three cancer clinics in the metropolitan Milwaukee area showed that patients and physicians agree on the goal of treatment less than half the time and that almost a quarter of patients do not have a realistic idea of the likelihood of achieving the goal.

"This appears to be a problem with how informed consent is used," Dr. Varma told Oncology News International. "Even when the doctor said palliation, half of the time the patient thought that chemotherapy should produce a cure."

Dr. Varma and colleagues surveyed cancer patients undergoing chemotherapy and their treating physicians. Dr. Varma was affiliated with Sinai Samaritan Hospital in Milwaukee at the time of the report, but beginning in July will be a fellow in medical oncology/hematology at Roswell Park Cancer Institute in Buffalo, New York.

Identifying Goals

Patients and physicians were asked to identify the goal of chemotherapy (cure or palliation) and the likelihood of achieving that goal. Subjects were also asked about life expectancy, chemotherapy toxicity, and the burdens and benefits of chemotherapy. Patient questionnaires were completed by direct interview, and compared to similar, self-administered, questionnaires completed by their oncologists.

Data were available from 74 of 75 patients and from 66 of 75 physicians. Patients had breast cancer (33%), lung cancer (15%), colon cancer (14%), lymphomas (9%), or other forms of cancer (29%).

"Overall agreement on the goal of treatment was poor," Dr. Varma reported. "When doctors identified the goal as palliation, 67% of patients thought that the goal of treatment was cure. However, in those cases where the doctors identified the goal as cure (20%), agreement with their patients was high (93%). When the doctor and patient agreed on the goal (45%), patients had higher expectations for success than their doctors—80% vs 60%," Dr. Varma continued.

Twenty-three percent of patients did not know the likelihood of achieving the identified goal of the chemotherapy. Sixty percent of patients did not know how long they might live without chemotherapy, or how much longer they might live with chemotherapy. Ninety-five percent of patients understood that chemotherapy had toxicity.

Communication Breakdown

"Also, the majority of patients were unaware of alternatives to the recommended chemotherapy treatment," Dr. Varma said.

Patients and physicians share an unrealistic notion of how well they are communicating. Ninety-eight percent of patients and 94% of doctors were satisfied with the patients’ understanding of the burdens and benefits of chemotherapy.

"Even though doctors and patients think that patients have a good understanding about chemotherapy, the vast majority of patients fail to understand two of the three essential components of adequate informed consent," Dr. Varma said. "They understand the risk of chemotherapy, but they do not understand the benefits or alternatives to the proposed treatment. We must therefore question the adequacy of our current informed consent process."

The answer might appear to be more written information for the patient and more time for discussion between patient and physician. In the current healthcare environment, however, "spending more time may not be a realistic option for these doctors," Dr. Varma observed.