ASCO GI 2007: Patient Communication and Expectations

ASCO GI 2007: Patient Communication and Expectations

January 19-21Orlando, FloridaAllyson Ocean, MD, Weill Medical College, Cornell UniversityThe content presented here was prepared by independent authors under the editorial supervision of OncoEd and is not endorsed or sanctioned by the 2007 Gastrointestinal Cancers Symposium.

The 2007 Gastrointestinal Cancers Symposium held January 19-21 in Orlando, Florida, was the fourth annual multidisciplinary symposium on gastrointestinal (GI) cancers, bringing together leading experts to present and discuss new research on prevention, screening, and treatment. Dr. Neil Love and colleagues presented an abstract titled, “How well do we communicate with our patients? A survey of patients who received adjuvant chemotherapy for colorectal cancer.”[1]

For colorectal cancer patients with stage II disease, the role of adjuvant treatment with chemotherapy has been unclear since surgery is curative in most of these patients. Although there are ongoing studies that may help to identify patients at high-risk of recurrence, currently we are unable to identify which stage II patients may benefit from adjuvant chemotherapy.[2],[3] In 2004, the ASCO panel issued guidelines that recommended that physicians talk to their patients about treatment options and consider their preferences, yet did not recommend adjuvant chemotherapy as a standard for stage II colorectal cancer.[4]

Dr. Love et al surveyed 150 colorectal cancer patients who had undergone surgery and chemotherapy within the past five years. In addition, 150 practicing medical oncologists and 23 clinical investigators were surveyed.

More than a third of the colorectal cancer survivors surveyed said they would be willing to undergo a repeat course of highly toxic therapy for even a minuscule (1%) reduction in the risk of recurrence. Of note, 57% of patients said they would willingly agree to another course of chemotherapy if it guaranteed a 3% absolute reduction in risk of recurrence. But when Dr. Love asked 150 medical oncologists to predict how many patients would be willing to repeat chemotherapy for a 1% reduction in risk of recurrence, the results were quite different. The oncologists estimated that only 19% of their patients would agree to the toxic re-treatment. “This survey demonstrates that patients may be far more willing to receive cytotoxic therapy for what others might view as modest potential treatment benefits,” Dr. Love said.

“The finding points out a problem that has no easy solution,” he said, adding that, “when a patient receives a diagnosis of cancer, something happens to that person that people who are not patients-including oncologists–do not fully understand.” These findings emphasize the importance of physician and patient communication.

Dr. Love also surveyed the patients about their expectations concerning cancer treatment and about their source of information about their disease. According to the study, colorectal cancer patients are receiving their information about cancer treatments from the Internet and from friends or relatives. In both instances the information was often wrong or incomplete. For example, “many patients based their expectations about hair loss, nausea, and vomiting on what they had heard about breast cancer chemotherapy, but the toxicities are much different for colorectal cancer treatments,” he said. As a result, two thirds of the patients said that hair loss was not as bad as they anticipated and 57% said that nausea or vomiting was not as bad. By contrast, of the patients who received Eloxatin® (oxaliplatin)-based regimens, 46% said that numbness in the fingers and toes was worse than they expected and 38% said cold intolerance was worse. This finding indicates that there is a need for oncologists to discuss the information their patients have gathered from friends, family and the Internet and help them understand and apply this information to their particular disease and treatment options.

References:

[1] Love N, Bylund C, Meropol N, et al. How well do we communicate with our patients? A survey of patients who received adjuvant chemotherapy for colorectal cancer. Proceedings of the American Society of Clinical Oncology Gastrointestinal Cancers Symposium. Orlando, Fla. 2007. Abstract 239.

[2] Midgley R, Kerr DJ. Adjuvant chemotherapy for stage II colorectal cancer: The time is right. Nat Clin Pract Oncol 2005;2:364-369.

[3] Witzig TE, Loprinzi CL, Gonchoroff NJ, et al. DNA poidy and cell kinetic measurements as predictors of recurrence and survival in stages B2 and C colorectal carcinoma. Cancer. 1991;68:879-888.

[4] Benson AB iii, Schrag D, Somerfield MR, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004;22:3408-3419. Abstract.

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