Are cancer patients hopes for chemo too high?

October 25, 2012 Malaysian Insider

A patient receives chemotherapy treatment for breast cancer in a file photo. Reuters pic NEW ENGLAND, Oct 25 At least two thirds of people with advanced cancer believed the chemotherapy they were receiving might cure them, even though the treatment was only being given to buy some time or make them comfortable, according to a US survey. Researchers reported in the New England Journal of Medicine that 69 per cent of patients who were terminally ill with lung cancer, and 81 per cent with fatal colorectal cancer, did not understand that their chemotherapy was not at all likely to eliminate their tumours. Their expectations are way out of line with reality, said lead researcher Deborah Schrag of the DanaFarber Cancer Institution in Boston, speaking to Reuters Health. Perhaps ironically, the patients who had the nicest things to say about their doctors ability to communicate with them were less likely to understand the purpose of their chemotherapy than patients who had a less-favourable opinion of their communication with their physicians. This is not about bad doctors and its not about unintelligent patients, said Schrag. This is a complex communication dynamic. Its hard to talk to people and tell them we cant cure your cancer. She added that doctors find it uncomfortable to hammer home grim news and patients dont want to believe it. The findings are based on interviews with 1,193 patients, or their surrogates, who had been diagnosed with cancer that had spread. All were receiving chemotherapy.

The fact that 20 to 30 per cent of respondents recognized that chemotherapy was not at all likely to cure them shows that at least some patients were able to accept this reality and to acknowledge it to an interviewer, the researchers wrote in the New England Journal of Medicine. The results are probably due, in varying degrees, to patients not being told their disease is incurable, patients not being told in a way that lets them understand, patients choosing not to believe the message, or patients being too optimistic, wrote Thomas Smith and Dan Longo of Johns Hopkins University School of Medicine. If patients actually have unrealistic expectations of a cure from a therapy that is administered with palliative intent, we have a serious problem of miscommunication we need to address, they added in a commentary with the report. Many patients think they are going to beat the odds. What are you supposed to do, stand in front of someone with advance disease and argue with them? Its not productive, said Hossein Borghaei, an oncologist at the Fox Chase Cancer Center in Philadelphia. But I hear that all the time, especially from the younger patients. Schrag said it was a reminder to doctors to slow down and take some time to realize how hard the issue is. Recognize that this is not one conversation, but typically a series of conversations to see if theyve understood it, and how theyre acting on it, she added. Reuters