Amy NortonReuters11:03 a.m. CDT, October 12, 2012

NEW YORK (Reuters Health) – When doctors recommend chemotherapy to people with incurable cancer, many of those patients may not understand that the treatment won’t save their lives, a small study finds.Cancer chemotherapy can have different goals. Often, the aim is a cure.

But chemo can also be “non-curative.” For some patients, chemotherapy can control the growth of the cancer for a while and prolong their lives. Other times, it’s palliative – intended to ease some of the symptoms of a patient’s cancer, without a hope of improving survival.

But in the new study, researchers found that those different goals are not always clear to patients.

Indeed, of 125 cancer patients surveyed at a large Boston hospital, one-quarter misunderstood the goal of their chemotherapy, the researchers report in the journal Cancer.

In most cases, they thought their non-curative chemo might actually cure them. But there were also some patients who didn’t think the goal was a cure, when in fact it was.

It’s hard to draw “hard and fast conclusions” about why the disconnect was there, said lead researcher Dr. Inga T. Lennes, of Massachusetts General Hospital.

But there were signs that communication barriers existed.

Patients whose native language was not English were more likely to misunderstand the goal of their chemo, versus native English speakers.

Those patients were able to speak and read English. And that’s a group of patients that tends to be “forgotten,” Lennes noted. They don’t need, or don’t want, a translator present. But they may still have some language difficulties.

“There are a lot of nuances in the conversation with the oncologists that might not get picked up,” Lennes said.

In contrast, some patients were less likely to misunderstand the goal of their chemo – namely, those who were given written materials on their treatment.

That doesn’t necessarily prove that the written information improved patients’ understanding. You’d need a study to test that idea, according to Lennes.

But the finding has already had practical implications at Massachusetts General, where written materials were always available, according to Lennes, but now they are being standardized.

Apart from communication barriers, there could be other factors influencing patient perceptions as well.

In the case of those who misunderstood their chemo as non-curative, it’s possible that some were actually basing that on their “internal understanding” of their disease, Lennes speculated.

Sometimes, she explained, chemotherapy is technically aimed at a cure, even when the likelihood of a cure is small (with later-stage lung cancer, for example). For some patients who viewed their chemo as non-curative, “that could be a reflection of their realism,” Lennes said.

But overly optimistic views were the more common issue. Of the 30 patients who misunderstood the goal of their chemo, 20 thought it was aimed at a cure when it was not.

And that’s in line with past studies that have found patients with advanced cancer often have a more optimistic view of their survival odds than their doctors do.

It’s not fully clear why that is, and there are probably various reasons. But experts think that less-than-ideal communication is one.

For patients, it’s important to ask questions – whatever medical condition you have, Lennes noted.

“Ask for as much information as you want,” she advised. “And make sure you understand the risks and benefits of any treatment.”

SOURCE: http://bit.ly/QnxCnQ Cancer, online September 25, 2012.