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Lynne Eldridge MD

Patient Misconceptions About Treatment Results With Stage 4 Lung Cancer

By October 26, 2012

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It seems to be a general thought that chemotherapy will rid the body of cancer. Even when a cancer is in the later stages - stage 4 - there seems to be a hope that perhaps in some people, chemotherapy will be curative. Kind of like the lottery.

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But that's not the case. And sadly, too few stage 4 lung cancer patients (and stage 4 colon cancer patients) understand that.

I have to admit, it's not just patients. Just recently I held on to a feeling that chemotherapy would cure a friend with stage 4 lung cancer. Somehow I thought that she would beat the odds, and a treatment that was only designed to lengthen life, would save hers. But that's, unfortunately, not how chemotherapy usually works for stage 4 cancer.

When chemotherapy is given for stage 4 lung cancer it can extend survival. People may live a few weeks longer. Maybe months longer. (An exception may be people treated with some of the targeted therapies such as Tarceva (erlotinib) in people with EGFR mutations or Xalkori (crizotinib) in people with ALK mutations.) Chemotherapy can also be palliative. In other words, it may kill off a part of a tumor resulting in an improvement in symptoms such as shortness of breath or coughing. But, it doesn't cure cancer. In other words, with rare but wonderful exceptions, it doesn't work like a miracle and completely clear a tumor for some fortunate people.

Researchers decided to see if patients understood this concept. In other words, what percent of patients were carrying a false hope that chemotherapy may cure their disease? The results brought tears to my eyes. 69% of stage 4 lung cancer patients (and 81% of stage 4 colorectal cancer patients) didn't understand that chemotherapy was not at all likely to cure their cancer.

It was interesting that patients who said they had good communication with their physicians were more likely to carry false hope that chemotherapy could be curative. Why? One possibility is that sharing the bad news results in patients being less happy with their physicians. Yet that's only speculation. It is, however, a thought that oncologists may wish to consider. Are they allowing their patients to feel this false hope in order to be "liked" better by their patients? On the other hand, are oncologists afraid that sharing the truth will remove hope?

Which brings up an important point. Hope. How can we help people with stage 4 lung cancer hang on to hope, while sharing the truth about treatments? What are your thoughts?

Check out this story beautifully shared by one of our About.com guides, Alison Doyle:

Photo: National Cancer Institute, Rhoda Baer (photographer)

Source:

Weeks, J. et al. Patients' Expectations about Effects of Chemotherapy for Advanced Cancer. The New England Journal of Medicine. 2012. 367:1616-1625.

Comments
October 27, 2012 at 12:54 am
(1) Seriously says:

Recently a very good friend was diagnosed Squamous Cell Lung Cancer Stage 3. I did a major amount of research for him & his wife just so they had easy access without wasting time doing it themselves. What I found astonishes me. The oncologist waited 3 weeks to start chemo, and did not discuss anything what so ever about options. She simply stated this 1 drug was it because the other 1 available had horrible side effects. No discussion on clinical trials or current news (Yavoy), no talk of angiogenesis drugs or diet, gamma knife, etc. There was no progression in the following weeks and then the doc decided to use radiation. Before he left to go home he became short of breath. He was admitted to the ICU and they found fluid around his heart that had cancer cells in it. By now I have found numerous trials that would of accepted him with these conditions. They stopped chemo and said thats all we can do. While we all realize its terminal had the doc bothered to keep up on current treatments they could have tried the newer protocols. She had no clue that a trial was beginning at the very facility she worked (Kaiser).
They accepted stage IV Non Small Cell Lung Cancer with heart problems. She never discussed palliative treatments.

October 27, 2012 at 3:34 pm
(2) lungcancer says:

Seriously — This is so sad to hear about your friend. Unfortunately, you aren’t alone. I wish we didn’t have to be our own advocates so much in the medical system, but we do. My heart goes out to everyone who has to navigate the system. Even with my own cancer — as a physician who has a little “inside” knowledge, and seeking care at a very reputable cancer center — I have had countless times that I have had to be my own advocate to get the care we all deserve with cancer. That has included both finding treatments on my own that weren’t offered, and refusing treatments in which I felt the risks outweighed the benefits. We do have a guide at about.com that covers how to be your own advocate in navigating the medical system. The url of her site is http://patients.about.com and I have used her articles often both to share with my readers, and to help me in my own journey with cancer.

October 28, 2012 at 1:18 am
(3) Seriously says:

What is really sad is he just seemed overnight to give up. His Doc. convinced him very quickly to accept it. He trusts her and never questioned it. It had not spread to his bones,head,neck only to a lymph node. I guess not everyone has the tenacity to research for hours & days. Mine is natural as I have a severely handicapped child that has odd problems, ones that have been missed by her docs. (Celiacs, osteoporosis,grand mal seizures caused by a faulty baclofen Pump, aspirating from over filling her feeding tube >> 36+pneumonias to which I stopped and fed her slowly and less & shes had 0 pneumonias its now been 6 yrs.) I feel so sad my friend has no one that is fighting for him. You should not have to waste your energy/health seeking treatments. What is wrong with our world? No one cares is the problem or very few.

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