Expert Point of View: Joseph Greer, PhD

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“These data are consistent with other studies we have conducted in advanced lung cancer, in which we similarly found that one-third of patients believed that their metastatic lung cancer was curable. These patients ostensibly already had conversations with their oncologists about their prognosis and treatment expectations,” said Joseph Greer, PhD, Program Director of the Center for Psychiatric Oncology and Behavioral Sciences at Massachusetts General Hospital, Boston. “The finding has been replicated in the scientific literature, which shows that a subset of patients with metastatic cancer report that it is curable.”

Reasons for This Gap

The reasons are multifactorial for this gap between oncologists’ conversations with patients and patient expectations, according to Dr. Greer. It’s not just that oncologists may need to improve their efforts at communicating realistic expectations from cancer treatment, but other factors come into play, including patients’ coping styles and the methodology for surveying patient expectations.

“It’s not just a one-off conversation with a patient. The necessary communication skills speak to the importance of an ongoing conversation with a patient. Also, expectations are tied to patients’ coping skills. It can be difficult to take in all the information when starting a new cancer treatment, and some patients may need more time to adjust to their situation. When communicating with patients, oncologists may need to come back to the purpose of treatment, so patients can understand more over time,” Dr. Greer said.

Challenge of Methodology

Additionally, methodology of surveys and studies is very important, Dr. Greer emphasized. “How are we asking patients about their expectations? We don’t have good assessment tools. When we ask a patient ‘What is the primary goal of your cancer treatment,’ we present a range of forced choices, not an open-ended question. We know a subset of patients will say, ‘My primary goal is cure.’ But when you ask a patient what their oncologist’s goal is for treatment, that patient will often say ‘to control the cancer.’ So, you have a discrepancy there, and the patient may be stating his/her wish rather than the true goal of treatment and may intellectually know that cure is not possible,” he explained.

Clinicians probably clearly communicate that the goal of treatment in the metastatic setting is control of cancer. Some patients may not be ready to acknowledge that cure is not possible.

“The challenge is the methodology. To prove that oncologists are truly communicating clear expectations, we would have to audio record each patient encounter, and that is cumbersome and often not feasible,” Dr. Greer said. ■

Disclosure: Dr. Greer reported no potential conflicts of interest.

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