by Leslie Orr, University of Rochester Medical Center
Distribution of prognostic understanding regarding curability and life expectancy estimates reported by patients and oncologists. A, Patients and oncologists were asked about their beliefs about the curability of the cancer: “What do you believe are the chances the cancer will go away and never come back with treatment?” Any response other than 0% for curability was considered poor prognostic understanding regarding curability (59% [206 of 348]; responses of uncertain were excluded). B, Patients and oncologists were asked: “Considering your (the patient’s) health, and your (the patient’s) underlying medical conditions, what would you estimate your (the patient’s) overall life expectancy to be?” Response of life expectancy of more than 5 years was considered poor prognostic understanding regarding life expectancy estimates (41% [205 of 496]). Credit: DOI: 10.1001/jamanetworkopen.2022.0018
Older people with advanced cancer tend to have an unclear understanding of how long they will likely live and overly optimistic beliefs about whether their cancer is curable, according to a Wilmot Cancer institute study published in JAMA Network Open.
Some oncologists, too, were noted in the study to be quite optimistic. In fact, 22 percent thought that a cure was possible, even though the patients who participated in this study were required to have incurable, advanced cancer.
The consequences of discordant beliefs can impact how health care is delivered: For example, researchers found that more hospitalizations and lower use of hospice services was a result.
The study conveys several important messages, including that nothing in medicine is 100%, said lead author Kah Poh “Melissa” Loh, M.B.B.Ch., B.A.O., M.S., assistant professor of Hematology/Oncology at the University of Rochester Medical Center and a geriatric oncology specialist at Wilmot.
Although it is rare, some people with stage 4 cancer with limited cancerous lesions have been cured or at least stabilized to enable a long life despite their cancer being technically incurable, she said. And, oncologists want to preserve hope.
But the study also shows that misunderstandings about what is more likely to happen can lead to unexpected hardship.
“Older individuals with poor understanding of the outlook of their cancer may be less likely to utilize resources such as hospice services that can address the needs of patients nearing the end of life and their families,” Loh said. “Individuals are also more likely to receive care that may not be consistent with their priorities. The study tells us that we need better ways to help people understand terrifying news.”
Loh has been researching the breakdown of communication between doctors and patients with late-stage cancer, and the outcomes of the discordance, for several years.
The current study and prior research analyzed data from a cohort of 541 patients with a mean age of 76, who agreed to participate in a national, randomized clinical trial about understanding prognosis. The JAMA Network Open study noted that approximately 60 percent of doctor-patient pairs had different beliefs about curability and 72 percent had misunderstandings about life expectancy.
Prior studies published in 2019, conducted by Loh and her collaborators, also showed that merely telling a patient the facts about prognosis is not enough. It’s important to draw out personal beliefs; some patients are willing to trade quality of life for longer survival, for example.
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