Anticancer Treatment Goals and Prognostic Misperceptions among Advanced Cancer Outpatients

Abstract

(1) Background: In the context of cancer incurability, the communication processes involving clinicians and patients with cancer are frequently complex. (2) Methods: A cross-sectional study that investigated outpatients with advanced cancers and their oncologists. Both were interviewed immediately after a medical appointment in which there was disease progression and/or clinical deterioration, and were asked about the patient’s chance of curability and the goals of the prescribed cancer treatment. The patients were asked whether they would like to receive information about prognosis and how they would like to receive it. The analyses of agreement on perceptions were performed using the Kappa’s test. (3) Results: the sample consisted of 90 patients and 28 oncologists. Seventy-eight (87.6%) patients answered that they wanted their oncologist to inform them about their prognosis; only 35.2% (n = 31) of them said they received such information at their present appointment. Regarding how they would prefer prognostic disclosure, 61.8% (n = 55) mentioned that the oncologist should consider ways to keep the patient’s hope up; 73% (n = 65) of the patients reported odds >50% of cure. The agreement between oncologists’ and their patients’ perceptions regarding the treatment goals and curability was slight (k = 0.024 and k = 0.017, respectively). (4) Conclusions: The perceptions of patients and their oncologists regarding the goals of treatment and their chances of cure were in disagreement. New approaches are needed to improve the communication process between oncologists and patients with advanced cancer.

To Treat or Not to Treat? Dilemmas when Deciding on Antineoplastic Treatment in Patients With Far Advanced Cancers

“…Often, patients with advanced cancers undergoing chemotherapy report an inaccurate perception of curability. 81 , 82 Prognostication is a dynamic and multi-step process encompassing the sequence of prognostic prediction, prognostic disclosure, prognostic awareness, prognostic acceptance, and prognostic-based decision-making. 83 In fact, when patients are aware of their disease stage and prognosis and, preferably, emotionally accept the situation, the clinical decisions to treat or not to treat them are facilitated by sharing decisions in a mature way and with potentially less distress.…”

“…Below are some examples of open, in-depth questions, oncologists may use to identify and understand the patient's wishes, preferences, beliefs, and values [84][85][86] To understand the profile of patient care preferences and to serve as a stimulus for further discussion about cancer treatment, we have been using in practice the following tradeoff item from a previous publication 81 : "If you could choose only one of the options, would you prefer... (A): a treatment that was designed to prolong life as much as possible, even if the treatment caused more pain and discomfort; or (B): a care plan to relieve pain and discomfort as much as possible, even if it meant not living as long." Other ways of assessing health care preference in a similar way, particularly in the elderly with cancer, have been described.…”