Wanting more

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.  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.