Patients' Expectations about Effects of Chemotherapy for Advanced Cancer

TLDR

Chemotherapy for metastatic lung or colorectal cancer can extend survival by weeks or months but is not curative, and its palliative role is well recognized. The study aimed to determine how many patients expect chemotherapy to be curative and to identify clinical, sociodemographic, and health‑system factors linked to that expectation. Using patient surveys and medical record reviews, the authors found that 69 % of lung cancer patients and 81 % of colorectal cancer patients did not realize chemotherapy was unlikely to cure their disease. Multivariable analysis showed higher odds of inaccurate beliefs among colorectal patients versus lung patients (OR 1.75), among non‑white and Hispanic patients (OR 2.82–2.93), and among those reporting very favorable physician communication (OR 1.90); education, functional status, and decision‑making role were not associated, and many patients’ lack of understanding could compromise informed decisions, though improving understanding may reduce satisfaction. The study was funded by the National Cancer Institute and other agencies.

Abstract

Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative.We studied 1193 patients participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) study (a national, prospective, observational cohort study) who were alive 4 months after diagnosis and received chemotherapy for newly diagnosed metastatic (stage IV) lung or colorectal cancer. We sought to characterize the prevalence of the expectation that chemotherapy might be curative and to identify the clinical, sociodemographic, and health-system factors associated with this expectation. Data were obtained from a patient survey by professional interviewers in addition to a comprehensive review of medical records.Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. In multivariable logistic regression, the risk of reporting inaccurate beliefs about chemotherapy was higher among patients with colorectal cancer, as compared with those with lung cancer (odds ratio, 1.75; 95% confidence interval [CI], 1.29 to 2.37); among nonwhite and Hispanic patients, as compared with non-Hispanic white patients (odds ratio for Hispanic patients, 2.82; 95% CI, 1.51 to 5.27; odds ratio for black patients, 2.93; 95% CI, 1.80 to 4.78); and among patients who rated their communication with their physician very favorably, as compared with less favorably (odds ratio for highest third vs. lowest third, 1.90; 95% CI, 1.33 to 2.72). Educational level, functional status, and the patient's role in decision making were not associated with such inaccurate beliefs about chemotherapy.Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them. (Funded by the National Cancer Institute and others.).