Patient vs Provider Views on Goals and Adverse Effects of Cancer Therapy
In a study reported in the Journal of Oncology Practice, Duckworth et al found that many patients with cancer had more optimistic treatment goals vs their physicians and that patients who did not understand adverse effects associated with treatment had higher distress scores.
As stated by the investigators, “Adequate understanding of the goals and adverse effects of cancer treatment has important implications for patients’ decision-making, expectations, and mood.”
Study Details
The study involved 100 patients and 34 providers at Wake Forest Baptist Comprehensive Cancer Center. Patients completed several instruments (National Comprehensive Cancer Network® Distress Thermometer, Medical Outcomes Study Social Support Survey, Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-General questionnaire, and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being questionnaire), as well as a 13-item survey on the goals and adverse effects of treatment. Physicians completed a 12-item survey on goals and adverse effects of treatment for each patient. Overall, 65 of 100 provider surveys were completed on the same day that patients completed their survey, and 84 of the 100 provider surveys were completed within 7 days (mean completion time difference = 5 days).
Most patients were white (84%), married (73%), and college-educated (68%). The most common cancer types were breast cancer (n = 17), leukemia and myelodysplastic syndrome (n = 15), and lung cancer (n = 14); 24 patients had stage IV disease. Among physicians, 26 were medical oncologists, 5 were radiation oncologists, and 3 were surgical oncologists.
Key Findings
Patient and provider dyads agreed in 61% of cases on the intent of treatment.
Seventy-three percent of patients reported that treatment was curative vs 50% of physicians; 22% vs 28% reported the goal was to extend life for several years, 3% vs 19% reported the goal was to extend life for 6 to 12 months, and 1% vs 3% reported the goal was to make the patient more comfortable, but not extend life.
Thirty-six percent of patients reported more optimistic therapy goals and 3% reported less optimistic goals vs providers. Forty-six percent of patients with stage IV disease reported more optimistic treatment goals vs providers.
Patients and provider dyads agreed 69% of the time on patient acknowledgement and understanding of adverse effects. Patients who reported an understanding of likely adverse effects had significantly lower distress scores on the distress thermometer than those not understanding likely adverse effects (mean = 2.5 vs 4.1 on 10 point scale, P = .008).
The investigators concluded: “Timely data capturing of patient/provider dyadic ratings is feasible. A significant discrepancy exists between a substantial percentage of patients’ and providers’ views of the intent and adverse effects of treatment. Patients were almost always more optimistic about the intent of treatment. Higher rates of distress were noted in cases of discordance. Providers may benefit from conversational feedback from patients as well as other integrated feedback systems to inform them about patient understanding.”
Katharine E. Duckworth, PhD, of the Section of Hematology and Oncology at Wake Forest Baptist Medical Center, is the corresponding author for the Journal of Oncology Practice article.
Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit jop.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
