Advanced-stage cancer patients are making treatment decisions based on unrealistic expectations of chemotherapy, a problem that could worsen under the new national health care overhaul from President Obama.
A recent study by the Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) found that 69 percent of patients with advanced lung cancer and 81 percent of patients with colorectal cancer had inaccurate and overly optimistic expectations for how chemotherapy could help them.
Authors of the study, headed by researchers at well-respected Dana-Farber Cancer Institute in Boston, found that the misunderstandings were the most pronounced in patients who gave their doctors the highest ratings.
“This suggests that patients perceive physicians as better communicators when they convey a more optimistic view of chemotherapy,” wrote the authors of the study that was published last month in the New England Journal of Medicine. “Physicians may be able to improve patients’ understanding, but this may come at the cost of patients’ satisfaction with them.”
Future mesothelioma cancer patients may be faced with similar issues about their expectations of chemotherapy, especially now under new
care laws that provide financial incentives to hospitals that have higher patient ratings.
Chemotherapy Benefits Not ‘The Whole Story’
Mesothelioma, which is caused by an exposure to asbestos, is a rare cancer diagnosed in an estimated 3,000 Americans annually. There is no cure, and the disease often comes with a grim prognosis. The most successful treatment approach has been a combination of surgery, radiation and chemotherapy.
Although chemotherapy can be helpful to most cancer patients extending their lives for weeks or months it rarely is a cure for any advanced cancers. Physicians often must balance their assessment between realism and making patients happy.
“This is a cautionary tale,” lead study author Jane Weeks, professor at Harvard Medical School, told The Washington Post. “I think everyone agrees that satisfaction alone is an incomplete measure of quality. It doesn’t give you the whole story. I think this is an example of that.”
The study included 1,274 patients spread across the country at hospitals, treatment centers and clinics. Each was diagnosed with metastatic lung or colorectal cancer at least four months earlier and already had received chemotherapy.
This was the first study to involve such a varied cross-section of patients, and the results were startling to the researchers.
“I was really surprised,” Weeks said. “Prior studies have suggested maybe a third of patients don’t understand [chemotherapy]. I thought the numbers were disturbingly high.”
Financial Incentive Related to Chemotherapy Is Worrisome
Some cancer patients will opt against chemotherapy because of its toxic nature and the grueling side effects that can result. Some believe that prolonging their lives for a few weeks isn’t worth sacrificing the quality of life they will have in the days remaining.
“If patients do not know whether a treatment offers a realistic possibility of cure, their ability to make informed treatment decisions that are consistent with their preferences may be compromised,” Weeks said. “This misunderstanding may pose obstacles to optimal, end-of-life planning.”
What troubles some patient advocates and health care providers is that the financial incentive to earn higher patient ratings may cloud a doctor’s ability to give an accurate assessment of what chemotherapy can do.
According to The Wall Street Journal, nearly $1 billion in payments to hospitals will be made in the next year based on a governmental survey given to patients. Hospitals with lower scores will lose money. Those with higher patient scores will be receiving bonus money.
The survey is part of the payment-for-performance system built into the new health care law, which the majority of Americans have opposed.