The Hardest Conversation, Part 2

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Late-stage cancer patients often don’t understand that chemotherapy isn’t a cure but a palliative, as Kevin Charles Redmon told us last week. New research shared at the annual meeting of the American Society for Radiation Oncology today finds a similar trajectory for those receiving radiation treatments for incurable lung cancer. Some 64 percent of the 384 patients with stage III or IV lung cancer surveyed said they thought palliative radiation therapy they had received might help cure their cancer.

That echoes the study Redmon cited last week, in which 69 percent of lung cancer patients and 81 percent with colorectal cancer didn’t understand that chemo was very unlikely to be a “cure.”

The lead author of the latest study, radiation oncologist Aileen B. Chen of Boston’s Dana-Farber Cancer Institute, sounded a note very much like that heard in last week’s study about the role of doctors in getting an unpalatable message across.  “In order to help patients make informed decisions about radiation treatments near the end of life, health care providers need to improve communication and understanding about the goals and limitations of palliative RT,” Chechen was quoted in a release. “While palliative RT can be very effective at relieving symptoms from cancer, overly intensive care can also reduce patients’ quality of life and lead to significant time and financial burdens for patients and their families.”

And past studies have shown that being up front about palliative care can improve quality of life and may even extend survival a bit, even as the most heroic measures are sidelined. As Joanne Kenen wrote for us in 2010:

Jennifer Temel, an oncologist at Massachusetts General and the lead author of the study, said fellow cancer doctors often regard palliative care as a last-resort discipline, a place to turn to when cancer treatment fails — not as a companion treatment. “Patients can get expert cancer care and comprehensive palliative care at the same time,” she said in an interview summing up the study’s message.

There is, of course, a price to be paid for being candid. “Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them,” the authors of last week’s study, headed by Dr. Jane Meeks, concluded.

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