Few oncologists told patients about benefits, risks of palliative chemotherapy

Information was ‘vague or nonexistent’ in majority of cases.

Oncologists may not give their patients enough information about the benefits and drawbacks of palliative chemotherapy, which could limit patients’ ability to make informed decisions, according to the results of a study published in BMJ.

Researchers from the University of Bristol and University Hospitals Bristol NHS Foundation Trust in the United Kingdom recorded conversations between oncologists and 37 patients with advanced cancers. The researchers also interviewed patients before and after the patient discussed palliative chemotherapy at an initial consultation with an oncologist. All patients were told their cancer was incurable.

The researchers found that the amount of information physicians gave patients about how long palliative chemotherapy could extend their lives varied greatly. Some oncologists gave a rough estimate such as “about four weeks.” Others gave a time frame such as “a few months extra” or gave a vague answer like the therapy will “buy you some extra time.” Others physicians said nothing.

The researchers concluded that discussion of survival benefit was helpful for patients who had decided against chemotherapy, especially when explaining the decision to family members who wanted the patient to keep fighting the disease and when the oncologist had determined the patient was too sick to tolerate treatment.

According to the researchers, it was also important to manage patients’ expectations. They indicated that many patients prioritize survival vs. quality of life and by not discussing survival benefit, “there can be a considerable gap between patients’ hopes and what can usually be achieved.”

The researchers wrote that discussion of survival benefit is crucial, even for patients who do not want to talk about prognosis. Some oncologists confuse the two issues and so do not bring up survival benefit.

By not having that conversation, oncologists are keeping their patients from being able to make a fully informed decision about their treatment. Patients generally select survival vs. quality of life but may decide to forgo treatment if they understand that treatment is unlikely to help them, according to the researchers.

BMJ. 2008;doi:10.1136/bmj.a752.