Terminal Cancer Patients May Have Erroneous Chemo Beliefs

Patients who rate communication with their doctor favorably more likely to have inaccurate beliefs

WEDNESDAY, Oct. 24 (HealthDay News) -- Patients with stage IV metastatic cancer frequently do not understand that chemotherapy is unlikely to be curative, according to a study published in the Oct. 25 issue of the New England Journal of Medicine.

Jane C. Weeks, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues interviewed patients and reviewed medical records to examine the attitudes to chemotherapy of 1,193 patients participating in the Cancer Care Outcomes Research and Surveillance study. Participants were alive four months after diagnosis of metastatic (stage IV) lung or colorectal cancer and were receiving chemotherapy.

The researchers found that 81 percent of patients with colorectal cancer and 69 percent of those with lung cancer did not understand that the chemotherapy was unlikely to cure their cancer. Patients with colorectal cancer had a significantly increased risk of reporting inaccurate beliefs about chemotherapy (odds ratio, 1.75). The risk of reporting inaccurate beliefs was also significantly increased among nonwhite and Hispanic patients (odds ratio for Hispanic patients, 2.82; odds ratio for black patients, 2.93) and among patients who rated their communication with their physician very favorably versus less favorably (odds ratio for highest third versus lowest third, 1.90). Inaccurate beliefs about chemotherapy were not associated with educational level, functional status, or the patient's role in decision making.

"Our results suggest the need for targeted education to help all physicians learn to communicate honestly while also maintaining patients' trust and regard," the authors write. "Efforts to incorporate earlier and more effective end-of-life care must address honestly and unambiguously patients' unrealistic expectations about the outcomes of chemotherapy."

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