Blog | Tuesday, March 19, 2013

QD: News Every Day--Oncology clinicians, patients balk at the word 'cure'


Cancer patients hesitate to ask whether they are cured, and clinicians hesitate with using the other "c" word themselves, a study found.

Oncology clinicians (physicians, nurse practitioners and physician's assistants) at the Dana-Farber Cancer Institute were invited to complete a 19-question survey about using the word "cure" in cancer care, and to evaluate outcomes of three case scenarios.

Results from the pilot study appeared in the Journal of Oncology Practice.

Of the 117 physicians (65%) who responded, 75% said they were hesitant to use the word, 66% would use the term when the risk of recurrence was either under 5% or essentially zero, and 20% reported that they never use the word. Clinicians reported that only 34% of patients ask if they are cured.

In case 1, a man was treated for testicular cancer 20 years ago. The seminoma was treated with chemotherapy and has had no evidence of disease since then. Overall, 83.9% (94 of 112) of clinicians considered the man cured. Physicians were significantly more likely to conclude that the patient was cured (92.9%) compared with nurse practitioners (55.6%) and physician's assistants (60%; P less than 0.001). Yet, 35.2% said that he still needs yearly oncology follow-up visits.

In case 2, a woman received CHOP chemotherapy for large-cell lymphoma 20 years ago and has had no evidence of disease since then. Overall, 75.9% (85 of 112) clinicians considered her cured, again with physicians significantly more likely to conclude that the patient was cured (83.1%) compared with nurse practitioners (63.2%) and physician's assistants (40%; P less than 0.005). Yet, 42.7% of them said she still needs yearly oncology follow-up visits.

In case 3, a woman was treated 20 years ago at age 47 for a stage 1, infiltrating, ductal breast cancer that was estrogen receptor positives. She received four cycles of Adriamycin and Cytoxan and then 5 years of tamoxifen and has had no evidence of disease since then. Overall, 48.2% (53 of 110) of clinicians considered her cured. Six respondents (5.6%) said she is not cured. Responses did not differ significantly by the type of clinician responding (P=.574). More than half (55.7%) of respondents said the woman still needs yearly oncology follow-up visits.

When asked after how many years in remission patients should be discharged from a cancer center and monitored by their primary physician, 31.7% said "Never." 61% were able to specify a certain number of years post-treatment, with 40% saying that cancer patients should be discharged from cancer follow-up in 5-10 years.

The authors noted that telling a cancer patient that he or she is cured can increase confidence and psychological adaption, but may also result in a decrease of medical care.

"For cancer survivors, the uncertainty about being cured could be an ongoing source of worry," the authors wrote. "Being in remission, rather than cured, may emphasize the importance of surveillance for cancer recurrence and result in less focus on the other tasks of cancer survivorship care, including screening for late and long-term effects and second or secondary cancers, time and effort spent on secondary prevention, and treatment of comorbidities, all of which become more relevant with increasing age."