Chemotherapy often misunderstood

Chemotherapy for metastatic lung or colon cancer may provide palliation and prolongation of life by weeks or months, but a new study shows that most patients with these diseases erroneously think that chemotherapy is curative. Researchers studied nearly 2000 patients in the Cancer Care Outcomes Research and Surveillance study who were alive 4 months after diagnosis of stage IV lung cancer or colorectal cancer. All patients received chemotherapy. 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." This misunderstanding about the benefits of chemotherapy was more prevalent among nonwhite and Hispanic patients as compared to non-Hispanic white patients (odds ratio [OR] for Hispanic patients 2.82, 95% CI, 1.51-5.25; OR black patients 2.93, 95% CI, 1.80-4.78). Patients who rated communication with their physician favorably also had a higher OR (1.90; 95% CI, 1.33-2.72). Educational level, functional status, and the patient's role in decision making were not associated with inaccurate beliefs about chemotherapy. The authors conclude that "many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative." This misunderstanding suggests that patients "have not met the standard for true ongoing informed consent" and may not accept toxic treatment with no reasonable hope of cure. The data also suggest that patients rate their doctors as better communicators if they are more optimistic. The authors suggest that honest communication is "a marker of quality of care" but may cause lower patient ratings (N Engl J Med 2012;367:1616-1625).