Older people with advanced cancer tend to have an unclear understanding of how long they will likely live and overly optimistic beliefs about whether their cancer is curable, according to a Wilmot Cancer institute study published in JAMA Network Open.
Some oncologists, too, were noted in the study to be quite optimistic. In fact, 22 percent thought that a cure was possible, even though the patients who participated in this study were required to have incurable, advanced cancer.
The consequences of discordant beliefs can impact how health care is delivered: For example, researchers found that more hospitalizations and lower use of hospice services was a result.
The study conveys several important messages, including that nothing in medicine is 100%, said lead author Kah Poh “Melissa” Loh, M.B.B.Ch., B.A.O., M.S., assistant professor of Hematology/Oncology at the University of Rochester Medical Center and a geriatric oncology specialist at Wilmot.
Although it is rare, some people with stage 4 cancer with limited cancerous lesions have been cured or at least stabilized to enable a long life despite their cancer being technically incurable, she said. And, oncologists want to preserve hope.
But the study also shows that misunderstandings about what is more likely to happen can lead to unexpected hardship.
“Older individuals with poor understanding of the outlook of their cancer may be less likely to utilize resources such as hospice services that can address the needs of patients nearing the end of life and their families,” Loh said. “Individuals are also more likely to receive care that may not be consistent with their priorities. The study tells us that we need better ways to help people understand terrifying news.”
Loh has been researching the breakdown of communication between doctors and patients with late-stage cancer, and the outcomes of the discordance, for several years.
The current study and prior research analyzed data from a cohort of 541 patients with a mean age of 76, who agreed to participate in a national, randomized clinical trial about understanding prognosis. The JAMA Network Open study noted that approximately 60 percent of doctor-patient pairs had different beliefs about curability and 72 percent had misunderstandings about life expectancy.
Prior studies published in 2019, conducted by Loh and her collaborators, also showed that merely telling a patient the facts about prognosis is not enough. It’s important to draw out personal beliefs; some patients are willing to trade quality of life for longer survival, for example.
Several funders supported the Wilmot research, including the Wilmot geriatric oncology philanthropy fund, Loh’s funding as a former Wilmot fellow, the National Cancer Institute, the National Institute on Aging, and a PCORI Program grant by co-author Supriya Mohile, M.D., Loh’s mentor and the Philip and Marilyn Wehrheim Professor of Hematology/Oncology and a research leader at Wilmot.