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Many cancer patients expect palliative care to cure

By Kathryn Doyle

NEW YORK (Reuters Health) - In a survey of patients with terminal lung cancer, nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease.

Among the nationwide sample of patients with advanced lung cancers, four out of five thought the radiation would help them live longer and two in five believed it might cure their cancers.

"Radiation therapy can be used to relieve symptoms caused by metastatic lung cancer, such as pain from bony metastases, shortness of breath from lung tumors, or neurologic symptoms, such as weakness, from brain metastases," said the study's lead author, Dr. Aileen Chen of the Dana-Farber Cancer Institute in Boston.

Patients with metastatic lung cancer usually live less than a year, she told Reuters Health, and their radiation treatments are intended to improve quality of life for the time that remains, so Chen was surprised that so many patients believed they would cure them.

Previous studies have shown that cancer patients have unrealistic expectations for chemotherapy as well, according to Phyllis Butow, professor of psychology at the University of Sydney in Australia.

"Our experience is that it is common with many late stage cancers," Butow, who was not involved in the new research, told Reuters Health. "We have done studies with patients with all sorts of late stage cancers and found similar results," she said.

The current study included 384 people who were diagnosed with incurable lung cancer between 2003 and 2005 and were receiving radiation therapy. The patients answered questions about their expectations of the therapy.

Overall, 64 percent did not understand that radiation was not at all likely to cure them.

Older patients and ethnic groups other than whites were more likely to have inaccurate beliefs about their care, according to the results published in the Journal of Clinical Oncology.

Twenty percent of the patients expected radiation treatments were "very likely" to cure their cancer, and another 25 percent thought they were "somewhat likely." Less than 40 percent answered that the radiation was "not at all likely" to cure their cancer.

Seventy-eight percent believed radiation was "very" or "somewhat" likely to help them live longer.

There was no difference in overall survival time between patients who expected to be cured and those who did not.

Both patients and doctors may avoid conversations about prognosis for emotional reasons, which may drive these inaccurate beliefs, Butow said.

"It is bad, because it can lead to poor decision making where patients and their families feel driven to continue with toxic treatments that significantly reduce patients' quality of life and do not extend their lifespan," she said.

All cancer clinicians have probably come across this problem in their practice, said Dr. George Rodrigues, a radiation oncologist at the London Health Sciences Centre in Ontario, Canada.

"The more surprising finding of the study was the extent to which this phenomenon was detected, in nearly two thirds of patients," Rodrigues said in an email. "According to this data, nearly 2/3 of patients are agreeing to palliative radiotherapy with the misconception that this radiotherapy may cure their disease."

Lung cancer patients might be especially prone to misplaced expectations, he said, since they tend to have short survival times and 95 percent of cases are caused by cigarette or tobacco smoke, and those patients tend to have more guilt and shame about their disease and may be more emotionally susceptible.

"What needs to occur is specific research to identify evidence based strategies that can improve patient understanding of prognosis and goals of therapy," he said. "Just telling physicians to do a better job in communicating to patients is not likely to affect any meaningful change," he said.

SOURCE: http://bit.ly/172HIRs Journal of Clinical Oncology June 17, 2013.

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