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Patients with acute myeloid leukemia often overestimate likelihood of cure
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Patients with acute myeloid leukemia undergoing chemotherapy held perceptions of treatment risk and likelihood of cure that varied widely from their physicians’ perceptions, according to study results scheduled for presentation at the Palliative and Supportive Care in Oncology Symposium.
Patients tended to believe risk for dying of treatment-related causes was high, while also overestimating the likelihood of cure.
To date there is no standard for the management of older patients with AML. There is a need for these patients to understand their prognosis and the risks associated with treatment before making an informed decision about medical care, according to Areej El-Jawahri, MD, assistant professor of medicine at Massachusetts General Hospital.
“Older patients, particularly aged older than 60 [years], with AML face very difficult treatment decisions,” El-Jawahri said during a press conference. “Often, they are choosing between risky, intensive chemotherapy — which is usually given in the hospital and requires a prolonged 4-to-6-week hospitalization for a small chance of a cure — or they have to choose nonintensive, noncurative palliative chemotherapy with the goal of prolonging their life and maybe alleviating some of their symptoms and enhancing their quality of life.”
To better understand patients’ understanding of their prognosis and treatment, El-Jawahri and colleagues enrolled 100 patients newly diagnosed with AML from two tertiary care hospitals within 72 hours of initiating intensive (n = 50) or nonintensive (n = 50) chemotherapy.
At enrollment, 63% of patients reported it was somewhat likely and 28.3% reported it was extremely likely they would die due to treatment. Conversely, 80% of oncologists said death due to treatment was very unlikely (P < .001).
Researchers assessed patients’ and their oncologists’ perceptions of prognosis using the Prognosis and Treatment Perception Questionnaire at 1 month, at which time most patients had received laboratory results confirming their cancer type and stage. Results showed 90% of patients thought cure was somewhat or very likely, whereas 74% of oncologists said cure was unlikely or very unlikely (P < .001).
The disparity between patient and oncologist perceptions occurred for the intensive and nonintensive chemotherapy groups. However, researchers noted that 44% of patients in the nonintensive group believed it was very likely they would be cured, compared with none of their oncologists.
The study did not capture several important factors, including what was actually discussed between patients and their oncologists, and whether patients simply misunderstood or misheard the information conveyed to them by their oncologists, El-Jawahri and colleagues noted. Because the discussions were not audio recorded during the study, there are few additional details regarding barriers to accurate prognostic understanding in these conversations.
The study authors previously evaluated similar perceptions among patients with lung, colorectal and other cancers, as well as those undergoing hematopoietic stem cell transplantation. However, it appeared patients with AML had greater gaps in understanding of their prognosis compared with patients in other settings.
“We know that older patients with AML have substantial misperceptions about the risks of their treatment and they constantly overestimate the likelihood of cure compared with their oncologists’ estimate,” El-Jawahri said. “These prognostic misperceptions are especially striking in patients receiving nonintensive palliative chemotherapy. As a result, we really do need interventions to facilitate communication and ensure accurate prognostic understanding in this patient population, where understanding the treatment risk and prognosis can have a significant effect on their treatment choices and decisions.”
A shared understanding of the prognosis and treatment risk between clinician and patient is crucial, according to Andrew S. Epstein, MD, ASCO expert and medical oncologist at Memorial Sloan Kettering Cancer Center, who was not involved with the study.
“This study adds to the literature on the deficiencies that exist in accurate knowledge on both sides of this interface,” Epstein said. “I agree that interventions to facilitate communication around these matters are needed. Effective physician-patient communication is critical so that patients can have accurate understanding of treatment risks and likely outcomes and make better-informed decisions with their doctor.” – by Alexandra Todak and Chuck Gormley
Reference:
Nicholson S, et al. Abstract 43. Scheduled for presentation at: Palliative and Supportive Care in Oncology Symposium; Oct. 27-28, 2017; San Diego.
Disclosures: NCI funded this study. El-Jawahri reports no relevant financial disclosures. Please see the abstract for a list of all other authors’ relevant financial disclosures. Epstein reports a financial relationship with UpToDate.