Study shows most patients with incurable cancer still hold hope for a cure
A new study published in the New England Journal of Medicine reports that the majority of patients with advanced, metastatic, Stage 4 lung or colorectal cancers think that chemotherapy can cure their disease. Yet, in metastatic cancer, chemotherapy is not curative but rather intended to prolong life by weeks or months and help alleviate symptoms of cancer. This begs the question: Are patients not told the prognosis, or do most patients choose not to believe it?
Dr. Jane Weeks and colleagues investigated expectations of a cure among nearly 1200 patients with advanced, metastatic lung or colorectal cancers. Patients were asked to complete a questionnaire answering whether they thought their chemotherapy would (a) cure their disease, (b) extend their life, or (c) provide relief of symptoms. 69% of lung cancer patients and 81% of colorectal cancer patients thought chemotherapy was likely to cure their cancers. Education level and the patient’s role in decision-making did not impact the findings.
There is no right way to cope with living with an incurable disease. Every patient is different, and every patient must make choices for treatment based on his or her individual wishes. There is no wrong decision, only informed decisions. We need to ensure patients have the information they need to make that personal choice.
Patients need to know, “What is the diagnosis? What can I expect from the disease? What can I expect from treatment? What is the cost?” Healthcare practitioners need to provide a patient-centered support system, and continually ask, “Tell me what you understand. What is important to you? How are you coping with this?”
But surprisingly, patients who reported favorable communication with their physician were more likely to think chemotherapy would cure their metastatic disease, suggesting that patients view optimism as better communication. How do we reconcile positive communication with inaccurate expectations?
While some patients and families choose to plan and make the most of their remaining time, some patients don’t want to accept there is no hope for a cure. Even in the face of incurable, metastatic disease, treating cancer with hope is still the patient’s choice to make.
“Hope is the thing with feathers that perches in the soul, and sings the tunes without the words, and never stops at all.” – Emily Dickinson
Jane C. Weeks, M.D., Paul J. Catalano, Sc.D., Angel Cronin, M.S., Matthew D. Finkelman, Ph.D., Jennifer W. Mack, M.D., M.P.H., Nancy L. Keating, M.D., M.P.H., and Deborah Schrag, M.D., M.P.H. Patients' Expectations about Effects of Chemotherapy for Advanced Cancer N Engl J Med 2012; 367:1616-1625October 25, 2012DOI: 10.1056/NEJMoa1204410