SAN FRANCISCOMost cancer patients undergoing chemotherapy
expect to be cured, even when cautioned by their physicians that the
chemotherapy can only relieve symptoms, according to Geetha N. Varma, MD.
Research conducted at three cancer clinics in the metropolitan Milwaukee area
showed that patients and physicians agree on the goal of treatment less than
half the time and that almost a quarter of patients do not have a realistic
idea of the likelihood of achieving the goal.
"This appears to be a problem with how informed consent is
used," Dr. Varma told Oncology News International. "Even when the doctor said
palliation, half of the time the patient thought that chemotherapy should
produce a cure."
Dr. Varma and colleagues surveyed cancer patients undergoing
chemotherapy and their treating physicians. Dr. Varma was affiliated with Sinai
Samaritan Hospital in Milwaukee at the time of the report, but beginning in
July will be a fellow in medical oncology/hematology at Roswell Park Cancer
Institute in Buffalo, New York.
Patients and physicians were asked to identify the goal of
chemotherapy (cure or palliation) and the likelihood of achieving that goal.
Subjects were also asked about life expectancy, chemotherapy toxicity, and the
burdens and benefits of chemotherapy. Patient questionnaires were completed by
direct interview, and compared to similar, self-administered, questionnaires
completed by their oncologists.
Data were available from 74 of 75 patients and from 66 of 75
physicians. Patients had breast cancer (33%), lung cancer (15%), colon cancer
(14%), lymphomas (9%), or other forms of cancer (29%).
"Overall agreement on the goal of treatment was
poor," Dr. Varma reported. "When doctors identified the goal as
palliation, 67% of patients thought that the goal of treatment was cure.
However, in those cases where the doctors identified the goal as cure (20%),
agreement with their patients was high (93%). When the doctor and patient
agreed on the goal (45%), patients had higher expectations for success than
their doctors80% vs 60%," Dr. Varma continued.
Twenty-three percent of patients did not know the likelihood of
achieving the identified goal of the chemotherapy. Sixty percent of patients
did not know how long they might live without chemotherapy, or how much longer
they might live with chemotherapy. Ninety-five percent of patients understood
that chemotherapy had toxicity.
"Also, the majority of patients were unaware of
alternatives to the recommended chemotherapy treatment," Dr. Varma said.
Patients and physicians share an unrealistic notion of how well
they are communicating. Ninety-eight percent of patients and 94% of doctors
were satisfied with the patients’ understanding of the burdens and benefits
"Even though doctors and patients think that patients have
a good understanding about chemotherapy, the vast majority of patients fail to
understand two of the three essential components of adequate informed
consent," Dr. Varma said. "They understand the risk of chemotherapy,
but they do not understand the benefits or alternatives to the proposed
treatment. We must therefore question the adequacy of our current informed
The answer might appear to be more written information for the
patient and more time for discussion between patient and physician. In the
current healthcare environment, however, "spending more time may not be a
realistic option for these doctors," Dr. Varma observed.