The expectations of metastatic cancer patients regarding palliative chemotherapy: A Brazilian–German qualitative study

Abstract

Objective To explore the expectations of Brazilian and German patients regarding metastatic cancer and palliative chemotherapy. Methods Interviews with 48 metastatic cancer patients from Brazil and Germany were conducted. The interviews were transcribed and analyzed using the thematic analysis approach to identify common themes. The sociodemographic data were collected using an instrument developed by the authors. Results A total of 48 patients participated in the study (58% were Brazilian and 42% were German). Of all participants, 35% were men and 65% were women. The participants’ mean age was 41 years. The general idea captured from the interviewees’ speech was that their diseases were curable or “while there is chemotherapy, there is life”; thus, the data analysis enabled the elaboration of the central theme, entitled “Mistaken expectations of metastatic cancer patients regarding palliative chemotherapy: While there is chemotherapy, there is life,” with 5 subthemes, namely: (1) communication and expectations; (2) normal life; (3) the person behind the disease; (4) religiosity and spirituality; and (5) the fortitude to choose between continuing or discontinuing treatment. Significance of results Regardless of cultural aspects, patients with metastatic cancer on palliative chemotherapy tend to believe in the healing potential of treatments. Dividing expectations only into curable or incurable is insufficient, as even patients who have acknowledged the incurability of their disease expect to live, as long as they remain under treatment as if the disease did not exist.

Clinicians’ and Advanced Cancer Patients’ Estimates of Treatment Efficacy and Toxicity in Oncologic Treatment

“…Additionally, misconceptions of treatment goals by patients can be explained by coping strategies such as denial, which were well described in this patient population [36,37]. Overall, patients with advanced cancer often have overly optimistic expectations regarding their chances of survival and cure rates [3,5,34,38]. It is vital to understand treatment goals for patients so they can settle on more suitable decision-making aligned with their preferences and also be able to establish realistic expectations about treatment outcomes.…”

“…The perception of curability is a crucial factor in the management of advanced cancer [1]. Previous studies have shown that oncologists tend to be more realistic in their assessment of curability [2][3][4], considering relevant clinical and scientific factors, while patients with advanced cancer may have unrealistic hopes and expectations regarding the possibility of a cure [5,6]. While oncologists rely on their clinical experience and the available scientific evidence to evaluate the potential cure, patients may have higher expectations of a cure, which could have been influenced by non-medical information and success stories of treatment [2,3].…”