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Majority of Patients with Incurable Lung Cancer Have Inaccurate Expectations about Goals of Radiation Therapy

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Key Points

  • A majority of patients with incurable lung cancer did not report that palliative radiation therapy was "not at all likely" to cure their disease.
  • Factors associated with inaccurate belief included older age and nonwhite race/ethnicity, but did not include education level, income level, or physical function status.
  • Patients with inaccurate beliefs about cure with radiation therapy were also more likely to have inaccurate beliefs about chemotherapy in this setting.

Aileen B. Chen, MD, MPP, of Dana-Farber Cancer Institute and Brigham and Women’s Hospital, and colleagues in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium recently assessed patient expectations regarding goals of radiation therapy (RT) for incurable lung cancer. They found that while a majority of patients believed radiation therapy might help them live longer and reduce disease-related problems, a majority also did not report understanding that radiation therapy was "not at all likely" to cure them.

Study Details

The study, published in the Journal of Clinical Oncology, involved patients enrolled in a population- and health system–based cohort who were diagnosed with stage wet IIIB or IV lung cancer between 2003 and 2005 and received palliative radiation therapy. Patients or their surrogates (when patients were too ill) were asked: “After talking with your doctors about radiation therapy, how likely did you think it was that radiation would … Help you live longer? Cure your lung cancer? Help you with problems you were having because of your lung cancer?” Response options included “very likely,” “somewhat likely,” “a little likely,” “not at all likely,” “don’t know,” or refused.

A total of 384 patients completed surveys. Of these, 78% believed that radiation therapy was very or somewhat likely to help them live longer and 67% believed that it was very or somewhat likely to help them with problems related to their cancer. A total of 64% did not report that radiation therapy was not at all likely to cure them, indicating inaccurate beliefs about the role of palliative radiation therapy.

Factors Associated with Inaccurate Belief

Factors associated with inaccurate beliefs about cure were older age (inaccurate belief in 58% of those aged 21–54 years, 63% of those aged 55–64 years, 65% of those aged 65–74 years, and 70% of those aged ≥ 75 years; P = .02 overall) and nonwhite race/ethnicity (59% for whites, 75% for African Americans, and 77% for other; P = .009 overall). Patients whose surveys were completed by surrogates were less likely to have inaccurate beliefs than those completing surveys on their own (59% vs 66%; P = .04). No differences in frequency of inaccurate beliefs were observed according to sex, marital status, education level, income level, or physical function status.

Among 285 patients in the cohort who also completed surveys on expectations regarding chemotherapy in this setting, those with inaccurate beliefs about radiation therapy were significantly more likely to have inaccurate beliefs about chemotherapy (P = .002). Overall, 92% of patients with inaccurate beliefs about radiation therapy also had inaccurate beliefs about chemotherapy.  

The investigators concluded, “Although patients receiving radiation therapy for incurable lung cancer believe it will help them, most do not understand that it is not at all likely to cure their disease. This indicates a need to improve communication regarding the goals and limitations of palliative radiation therapy.”

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®.


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