USA Today reports on a survey presented at the 2007 Gastrointestinal Cancers Symposium in Orlando, indicating that colorectal cancer patients are more willing to undergo repeat chemo than their doctors think. (Study: Doctors out of sync with cancer patients’ wishes)
Thirty-five percent of patients who’d had surgery and drugs already said they would have chemo again –with all its side effects and dangers– for a 1 percent reduction in the chance of relapse.Â Less than 20 percent of physicians thought patients would agree to that deal. Drugmaker Sanofi-Aventis sponsored the survey, which is pretty a clear attempt to boost the use of drugs in hopeless situations, but it doesn’t mean the conclusions are wrong.
What could be the reason for the disconnect? Here are some possibilities:
- The physicians interpreted the question literally while patients treated the 1 percent as “a low chance”
- Patients who in healthier times would have been enthusiastic about “death with dignity” and foregoing excessive end-of-life care feel differently when doing nothing means inviting death. Meanwhile, oncologists, unfortunately, become used to seeing patients die and mentally write off patients who reach a certain stage
- Oncologists are making judgments about what should happen rather than what patients want. This is based partly on a concern about expending huge resources when the outcomes are likely to be poor
A co-author notes another possibility: by definition the respondents already lived through chemo, so may be more positive about it than they otherwise would. I don’t really buy that explanation as the physicians should have adjusted their answers to reflect that fact.January 23, 2007