Expectations too high for palliative chemotherapy

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Many persons who receive chemotherapy for incurable cancers may not understand that the treatment is unlikely to be curative, researchers have found. This could compromise a patient's ability to make informed treatment decisions that are in keeping with his or her preferences.

A total of 1,193 participants in the national, prospective Cancer Care Outcomes Research and Surveillance (CanCORS) study were surveyed and their medical records reviewed to determine what proportion of those patients thought chemotherapy might be curative. All patients had received chemotherapy for newly diagnosed metastatic (stage IV) lung or colorectal cancer.

Chemotherapy can alleviate pain and extend life for weeks or months in patients in the late stages of cancer. However, 69% of the persons with advanced lung cancer and 81% of those with advanced colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their disease.

The following groups were most likely to have inaccurate beliefs about their chemotherapy:

  • patients with colorectal cancer rather than lung cancer
  • nonwhite and Hispanic patients rather than non-Hispanic white patients
  • patients who rated their communication with their physician very favorably.

Educational level, functional status, and the patient's role in decision-making were not associated with inaccurate beliefs regarding chemotherapy.

The investigators noted that further research would be needed to identify strategies to help clinicians more consistently set realistic expectations and thereby help patients make good decisions about their care (N Engl J Med. 2012;367:1616-1625).

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