Different Perceptions on the Goals of Chemotherapy
A disconcerting presentation was made at the recent annual meeting of the American Society of Clinical Oncology in San Francisco. Dr. Geetha Varma of the University of Wisconsin Medical School reported on a study that found patients and their doctors often have very different opinions about the objectives and potential success of their chemotherapy treatment.
Varma reported on a survey of 88 patients undergoing chemotherapy and 79 doctors who were treating them. The purpose was to assess how each group viewed the treatment-both in terms of its objective (cure vs. palliation/easing of symptoms) as well as its likelihood for success. The surveys also evaluated each patient's understanding of the risks and benefits of chemotherapy.
The surveys were conducted at three cancer clinics in the greater Milwaukee area. Patient questionnaires were completed by direct interview, and then compared to similar, self-administered, questionnaires completed by their oncologists.
Varma's team found that most of the cancer patients believed that a "cure" was the goal of their chemotherapy treatment, while most of the doctors considered the chemotherapy to be "palliative" treatment to slow the cancer and/or ease symptoms.
When doctors identified the goal as palliation, 67 percent of patients actually thought that the goal of the treatment was a cure. However, in those cases where the doctors identified the goal as a cure (20 percent), agreement with their patients was high (93 percent).
Even when the doctors and their patients agreed on the specific goal of the chemotherapy, the patients were far more optimistic about its potential for success-82 percent vs. 59 percent.
In addition, the survey found that 60 percent of the patients did not know how long they might live without chemotherapy, or how much longer they might live with chemotherapy.
Incredibly, in spite of such widespread misunderstandings, 98 percent of the patients and 94 percent of the doctors said they were satisfied with the mutual level of understanding about the risks and benefits of chemotherapy.
Varma warned that the doctors and their patients agreed on the goal of treatment less than half of the time. Furthermore, she noted, almost a quarter of the patients had absolutely no idea how successful their treatment might eventually be.
Given such a wide disparity in understanding, Varma said the adequacy of the current informed consent process should be immediately called into question.
SOURCE:
Annual meeting of the American Society of Clinical Oncology, San Francisco, CA, May 15, 2001
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