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April 2017 VOL 8, NO 4
Patients’ Expectations of Treatment off Target
Despite consultations with oncologists about the goal of treatment, more than one-third of men with incurable prostate cancer believed that a cure was possible with the treatments they were about to receive. These findings from a survey at an academic center suggest that oncologists may need to have an ongoing conversation with patients to bring their expectations in line with what is possible.
Lead author of the study, Kelvin A. Moses, MD, PhD, Assistant Professor of Urology, Vanderbilt University School of Medicine and Chief of Urology, Nashville General Hospital, TN, said, “These results at a large academic center suggest that somehow, we are not communicating about expected outcomes. We have to become better communicators.”
Dr Moses said that in his experience, it may take repeated discussions to bring a patient’s expectations in line with the fact that their prostate cancer is incurable. He often has to repeat the conversation about treatment goals, he said.
“It’s a fine balance. We don’t want to kill optimism, and we don’t want to overtreat the patient. We do want to improve quality of life and extend survival with our treatments,” Dr Moses said.
This study, reported at the 2017 Genitourinary Cancers Symposium, is part of a larger survey of influences on treatment decision-making among men with metastatic prostate cancer.
Although a number of options are available for the treatment of metastatic prostate cancer, there is no cure. Current treatments can extend survival by about 5 months, Dr Moses said. With no definite standard of care, the discussion that providers have with patients will influence treatment selection.
Patients may be able to accept toxicity of treatments if they believe a cure is possible, Dr Moses explained.
Between June 1, 2015, and September 29, 2016, the study enrolled 100 men diagnosed with advanced, incurable, metastatic prostate cancer. Study subjects were recruited from patients treated at Nashville University Medical Center (n = 77) and from a link on the website of ZERO - The End of Prostate Cancer, a nonprofit patient advocacy organization (n = 23).
All patients were on hormonal treatments, and the vast majority was on second-line treatment with either abiraterone, enzalutamide, or sipuleucel-T.
At the time that the oncologist was introducing a new therapy, patients completed surveys of their expectations of their current treatments for cure, symptom relief, and extending survival.
Patients could choose from a list of responses ranging from “very likely,” “somewhat likely,” “a little likely,” “not at all likely,” and “don’t know.”
Of those surveyed, 33% said a cure was at least “somewhat likely,” and 8% of these respondents said a cure was “very likely.” Almost all patients (91%) expected that treatment would extend survival, and 70% felt that treatment could help their cancer-related symptoms to some degree.
A multivariate analysis adjusted for covariates found that greater optimism and better reported health status were associated with greater odds of expecting a cure from their treatment.
“Efforts to align patient and physician expectations are necessary to counsel patients adequately and avoid overtreatment with toxic therapies,” Dr Moses said.
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