Risks & Benefits of Adjuvant Chemotherapy for Colorectal Cancer: Are Your Patients Hearing What You're Saying?

ORLANDO—Better communication is needed between oncologists and their patients regarding the benefits and risks of adjuvant therapy, according to a study presented at the 2007 Gastrointestinal Cancers Symposium (abstract 239).

The researchers surveyed 150 colorectal cancer patients treated with adjuvant chemotherapy within the past 5 years and given an audio educational program on adjuvant chemotherapy. Of these patients, 36% said they would choose to be treated again with the same therapy for a reduction in risk of recurrence of just 1%, and 57% said they would choose to be treated again for a 3% reduction, reported Neil Love, MD, an oncologist and president of Research to Practice, a medical education company in Miami.

However, their doctors had different ideas about what they would choose. When Dr. Love asked a group of 150 medical oncologists and GI clinical investigators how many of their patients they thought would be willing to undergo the same chemotherapy for a 1% reduction in the risk of recurrence, the physicians thought that just 19% would choose the same treatment.

"This survey demonstrates that patients may be far more willing to receive cytotoxic therapy for what others might view as modest potential treatment benefits," Dr. Love said.

There were also some patients (12%) who said they would not have chemotherapy again, even with a 10% reduction in risk. "Even though we think we know our patients, this survey shows that there is still a lot about their reactions and expectations of treatment that we do not know. This is why surveys such as ours are potentially very useful," he said.

Erroneous Expectations?

Patients continued to have erroneous expectations about chemotherapy even after they were given educational CDs and videos to listen to and watch, and also had a chance to sit down and talk with researchers and oncologists about the risks and benefits of adjuvant chemotherapy.

"In spite of the fact that the adjuvant chemo for colorectal cancer that we use today, in contrast to that for breast and lung cancer, does not cause serious nausea and vomiting or hair loss, more than half of the patients in our survey expected this to happen. We think this is because they are listening to friends and relatives, and seem to hear them more than they hear us," Dr. Love said.

An encouraging finding was that more than 90% of the patients surveyed felt their physicians were doing a good job, grading their oncologists' overall care, how much time they spent with them and their empathy, as well as clinical expertise, as an A or B (on an A, B, C, D, F scale). Only a small number indicated they were not satisfied with the amount of information they were receiving from their oncologist.

The survey also found that 60% of the patients were not offered the opportunity to participate in a clinical trial, but that 81% of those patients wished they had received the information.

"Our findings underscore the importance of better communication between physicians and patients to ensure that physicians clearly understand patient expectations regarding treatment, and so that patients receive clear and accurate information about the risks and benefits of therapy," Dr. Love concluded.