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NEW YORK (Reuters Health) - Patients with incurable cancer are often not clearly informed of what they stand to gain from palliative chemotherapy, according to the study results published in BMJ Online First. As a result, British investigators say, patients may lack sufficient knowledge make a decision based on informed consent.
Palliative chemotherapy is not intended to cure patients of cancer, only to make their lives more tolerable. Nonetheless, this treatment may slightly improve survival.
Dr. Suzanne Audrey, at the University of Bristol, and colleagues observed and recorded 9 oncologists and 37 patients during consultations in which palliative chemotherapy for advanced lung, pancreas, or colon cancer was first discussed.
In all cases, patients were informed that their cancer could not be cured, and the purpose of palliative chemotherapy was explained. They were also informed about treatment options, common side effects and associated risks.
In 8 cases, survival was not discussed at all. In 18 cases, information was "vague," involving comments such as "about 4 weeks, a few months extra, and buy you some time." Only 6 patients were given numerical data about how much longer they would probably live if palliative chemotherapy were used.
"If the oncologist focuses on the benefits of palliative chemotherapy in terms of control of symptoms and quality of life, but omits information about survival benefit, the patient might assume much greater potential to prolong life than is likely to be the case," Audrey and colleagues suggest.
"Perhaps most difficult of all is when a patient, or their partner or carer, makes it clear that they do not want to receive any more bad news. Talking about life expectancy can seem cruel at this point," they continue. "But... supplying basic information about the survival benefit of treatment need not entail giving 'intrusive' data about prognosis."
Instead of evading the subject, the authors recommend that oncologists receive coaching on how to inform patients without taking away hope.
In a related editorial, Dr. Daniel F. Munday at Myton Hamlet Hospice in Warwick and Dr. E. Jane Maher at Mount Vernon Hospital in Middlesex urge researchers to investigate the dynamics of end-of-life consultations and to develop "decision aids" to help patients fully understand and interpret the information they are given.
SOURCE: BMJ Online First, August 1, 2008.
