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70+% of terminal cancer pts believe, wrongly, that they're on chemo to cure them. Who is to blame? Via @incidentalecon goo.gl/fb/BVonY
— Atul Gawande (@Atul_Gawande) October 25, 2012
This feels like the flip side of yesterday’s post, where big effects were often found to be outliers. In this study, patients were asked about their expectations for chemotherapy for metastatic lung or colorectal cancer. The bad news is that these cancers have terrible prognoses. Chemotherapy is still the treatment of choice, but the effect we’re hoping for is an extension of life by weeks to months. Maybe you’ll see some relief of symptoms. But it’s not going to be curative. There are also, of course, significant side effects.
This NEJM report spells out some hard truths.
Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative.
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.
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.