Better end-of-life communication needed in advanced cancer


21 Jul 2016

Improving doctor-patient communication in patients with advanced cancer could be a way of reducing overly aggressive treatment near the end of life, experts say.

Writing in this week’s JAMA Oncology Dr Jeffrey D. Robinson from the Portland State University, Portland, Oregon and colleagues said research had suggested that patients with advanced cancer often have inappropriately optimistic prognostic expectations, viewing treatment as curative rather than palliative.

“Given that patients’ preferences for aggressiveness of care can depend on their understanding of prognosis, a key question was whether physician-patient communication about prognosis is sufficiently robust,” they wrote. 

They were commenting on a study published in the journal that showed high rates of discordance in prognosis between patients and their oncologists.

Overall, the study of 236 patients with stage 3 or 4 cancers discovered that over two-thirds (68 percent) rated their survival prognosis differently than their oncologists. Of these patients only 1 in 10 realised that their opinion differed from their oncologist.

And in nearly all cases the patients were more optimistic than their doctors.

Of the 68 percent, only one in 10 realised that their opinions differed from their oncologists.

According to the research team led by author Professor Ronald M. Epstein from the University of Rochester Medical Center their results highlighted a difficult communications issue that is all too familiar when the conversation is about cancer.

Discordance almost always leans toward patients being overly optimistic, Professor Epstein said.

“Of course, it’s only possible for doctors to provide a ball-park estimate about life expectancy–and some people do beat the odds,” he said.

“Positive thinking by patients can improve quality of life. But when a patient with very advanced cancer says that he has a 90-100% chance of being alive in two years and his oncologist believes that chance is more like 10%, there’s a problem.”

Dr Robinson and colleagues said the findings provided clear evidence of the ongoing need for improved communication in the context of advanced cancer.

“After all, promoting more realistic prognostic estimates is a critical step toward improving patients’ quality of life and preference-concordant illness management decisions, including the reduction of overly aggressive treatments that many patients will otherwise continue to receive,” they concluded. 


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