MedWire News: Patients with end-stage cancer often do not understand the role of palliative radiotherapy, even after full disclosure of their prognosis and treatment aims, suggest study findings published in Clinical Oncology.
"A significant proportion of patients with advanced disease believe their cancer is curable, expect that radiotherapy will cure their cancer and prolong their life despite understanding the intent of radiotherapy is for symptom relief," report Gunita Mitera and co-workers, from Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
The researchers designed a survey to examine patient understanding of illness and expectations of palliative radiotherapy for relief of symptomatic metastases before and after attending a consultation with a radiation oncologist to discuss treatment.
The researchers recruited 100 patients, aged a median of 66 years, over half of whom were male (n=55). The most common diagnoses were primary lung, prostate, or breast cancer with metastases to the brain, spine, and/or pelvis.
The survey revealed that 96% of patients were satisfied with their consultation, with 24% reporting greater understanding of their illness and radiation therapy than before their consultation. Patients were less likely to have questions about radiation after meeting with their radiation oncologist than before (23 vs 60%).
After their consultations, patients were significantly more likely to know that radiotherapy could offer symptom relief and understand the role of radiation than beforehand, and were less concerned about treatment effectiveness and side effects.
Nevertheless, 23% of patients believed their cancer was curable before meeting their consultant and this figure did not change after discussion with their radiation oncologist.
Indeed, a substantial minority of patients believed before and after consultation that radiotherapy would cure their cancer (17 and 15%, respectively), or extend their life (40 and 45%).
The researchers note that patients with an unrealistic understanding of their prognosis did not significantly differ from those with good understanding in terms of age, performance status, disease extent, or treatment.
"The consultation can assist them with developing coping strategies, including helping patients to reframe 'cure and hope' realistically so they may have the opportunity to experience the intended benefit from radiation treatment, and subsequently carry out what is most important to them towards the end of their life," Mitera et al write.
"Understanding the 'cure' from a patient's perspectives should be explored, as well as further study to understand why some patients continue to believe their cancer to be curable may provide us with a deeper insight into patient psychology and coping mechanisms."
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