Patients’ expectations about effects of chemotherapy for advanced cancer
Open accessAbstract
BACKGROUND: Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative. METHODS: We studied 1193 patients participating in the Cancer Care Outcomes Research and Surveillance (CanCORS) study (a national, prospective, observational cohort study) who were alive 4 months after diagnosis and received chemotherapy for newly diagnosed metastatic (stage IV) lung or colorectal cancer. We sought to characterize the prevalence of the expectation that chemotherapy might be curative and to identify the clinical, sociodemographic, and health-system factors associated with this expectation. Data were obtained from a patient survey by professional interviewers in addition to a comprehensive review of medical records. RESULTS: Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer. In multivariable logistic regression, the risk of reporting inaccurate beliefs about chemotherapy was higher among patients with colorectal cancer, as compared with those with lung cancer (odds ratio, 1.75; 95% confidence interval [CI], 1.29 to 2.37); among nonwhite and Hispanic patients, as compared with non-Hispanic white patients (odds ratio for Hispanic patients, 2.82; 95% CI, 1.51 to 5.27; odds ratio for black patients, 2.93; 95% CI, 1.80 to 4.78); and among patients who rated their communication with their physician very favorably, as compared with less favorably (odds ratio for highest third vs. lowest third, 1.90; 95% CI, 1.33 to 2.72). Educational level, functional status, and the patient's role in decision making were not associated with such inaccurate beliefs about chemotherapy. CONCLUSIONS: Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them. (Funded by the National Cancer Institute and others.).
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Many patients with advanced cancer do not fully understand that their treatment is palliative.
“Many patients with advanced cancer, for example, do not fully grasp the palliative intent of their treatment (158).”
From Artificial Intelligence in Oncology: Current Landscape, Challenges, and Future Directions (2024) · cites this paper as [158]
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- Authors
- Weeks, J. C., Catalano, P. J., Cronin, A., Finkelman, M. D., Mack, J. W., Keating, N. L., & Schrag, D.
- Affiliations
- Dana-Farber Cancer Institute (US)
- Tufts University (US)
- Harvard University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-10-25
- Volume
- 367
- Issue
- 17
- Pages
- 1616-1625
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3613151
- OpenAlex
- W2160733129
- Cited by
- 1,149
- References
- 40
- Citations by year
- 2026: 28 · 2025: 45 · 2024: 58 · 2023: 70 · 2022: 57 · 2021: 81 · 2020: 109 · 2019: 88 · 2018: 95 · 2017: 121 · 2016: 97 · 2015: 112 · 2014: 95 · 2013: 83 · 2012: 6
- FWCI
- 168.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- other-oa
- Locations
- New England Journal of Medicine (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5u01ca093344-08)
- National Cancer Institute (U01CA093339, U01CA093326, U01-CA093344, U01CA093348, U01CA093329, U01CA093332, U01CA093324)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- metastatic lung cancer, metastatic colorectal cancer, treatment knowledge, physician-patient communication, racial and ethnic disparities, palliative chemotherapy, patient satisfaction
- MeSH terms
- Adult, Aged, Aged, 80 and over, Attitude to Health, Data Collection, Decision Making, Drug Therapy, Female, Humans, Informed Consent, Lung Neoplasms, Male, Middle Aged, Neoplasm Staging, Colorectal Neoplasms, Cohort Studies, Logistic Models
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