|
 “That the vast majority of cancer patients who are dying say that
they want to know their prognosis seems surprisingly courageous,”
said senior author Holly G. Prigerson of Weill Cornell Medical
College in New York City.
Every patient needs to know their prognosis, including life
expectancy, and expected outcomes of treatment, for example they
should know that chemotherapy cannot cure incurable cancer,
Prigerson said.
“Providers often are reluctant to communicate grim news, as anyone
would be,” she said.
The study included 590 patients with advanced, metastatic cancer who
had been treated with at least one round of palliative chemotherapy,
which is meant to improve comfort rather than to cure.
Researchers asked the patients whether their oncologist had ever
given them a prognosis with a life expectancy estimate, then asked
the patients to estimate their own life expectancy and to complete
assessments of emotional distress, whether they had advance
directives and their end-of-life care preferences.
The patients also described their relationship with their doctors.
Half of the patients survived for less than six months after the
study began.
About 70 percent wanted to be told their life expectancy, but only
about 18 percent recalled having this discussion with their
oncologist.
Half of the patients were willing to estimate their own life
expectancy, and those who remembered having a prognosis conversation
with their doctor estimated a life expectancy closer to their actual
survival than those who did not.
Less than 10 percent of those who remembered having a conversation
with their doctor made estimates that were more than five years
longer than their actual survival. That compares with 35 percent of
those who did not remember having the conversation who overestimated
their life expectancy by more than five years.
Remembering a prognostic discussion with a doctor decreased patient
estimated life expectancy by about 17 months, when the researchers
accounted for other factors, according to the results in the Journal
of Clinical Oncology.
[to top of second column] |
Talking to a doctor about life expectancy was not tied to worse
doctor-patient relationship, more sadness or higher anxiety, the
surveys found.
“It is encouraging that the patients who reported a prognostic
disclosure by their oncologist were more realistic in their
life-expectancy estimate, more likely to complete a (Do Not
Resuscitate) order and to want comfort care,” Prigerson told Reuters
Health by email.
“There was no emotional fallout that damaged their relationship with
their oncologist – as reported by the patient,” she said.
Often these conversations should happen, but they do not, for a
multitude of reasons, she said. The patient may not be ready to hear
bad news, some patients may reject information they are given
because they believe a miracle may happen, and other reasons, she
said.
“Some patients are not able to hear and process poor prognoses and
more harm than good can be done by forcing the situation,” Prigerson
said. “However, we have found that over 90 percent of patients
benefit from prognostic disclosures and it is a minority of patients
for religious or personal or social reasons that do not benefit.”
SOURCE: http://bit.ly/1LihXSR Journal of Clinical Oncology, online
October 5, 2015.
[© 2015 Thomson Reuters. All rights
reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
