Surveying a population-based and health system–based cohort of patients receiving radiation therapy for incurable lung cancer (defined as stage IV or stage IIIB with malignant effusion at diagnosis) revealed that “64% did not understand that [radiotherapy] was not at all likely to cure them.” These results from the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) were reported in Journal of Clinical Oncology.
Among 384 patients who completed surveys on their expectations about radiotherapy, 90% had stage IV disease and 82% had non–small cell lung cancer. Regarding expectations about treatment, 67% believed that radiotherapy was “very or somewhat likely to help them with problems they were having because of their cancer,” 78% thought that radiotherapy was “very or somewhat likely to help them live longer,” and 43% felt that radiotherapy was “very or somewhat likely to cure their cancer,” the investigators reported. “We did not observe significant differences in overall survival on the basis of patient expectations about the likelihood of [radiotherapy] helping them live longer or curing their cancer,” they added.
Multivariate analysis, controlling for factors such as education and income, found that surveys completed by older patients and nonwhites were more likely to report inaccurate beliefs, while surveys completed by surrogates (because the patients themselves were too sick) were less likely to show inaccurate beliefs. Among the 285 patients in the cohort who also completed survey items concerning chemotherapy, 92% with inaccurate beliefs about cure from radiotherapy also had inaccurate beliefs about chemotherapy.
The authors concluded that unrealistic expectations about the effectiveness of radiation therapy given to patients with incurable lung cancer indicate the need for clear and accurate information about the goal and limitations of palliative radiotherapy.
“Patients cannot make well-informed decisions about their end-of-life care, taking into account risks and benefits of treatment, if they hold inaccurate beliefs about the goals of care,” they pointed out. “Studies have shown that patients with advanced cancer who do not understand and overestimate their prognosis are more likely to pursue intensive therapies near the end of life. These therapies may reduce quality of remaining life and incur substantial costs for patients with limited life expectancy.”
The investigators continued, “In particular, palliative [radiotherapy] requires daily visits for treatment, which can be burdensome for patients and families. It is possible that patients who understand that [radiotherapy] is not at all likely to result in cure might choose to forgo [radiotherapy] or pursue shorter courses of treatment. Although randomized studies suggest that short courses of [radiotherapy] are equally effective in many patients with poor prognosis, lengthier courses are more commonly given.” ■
Chen AB, et al: J Clin Oncol. June 17, 2013 (early release online).