Chemotherapy information not given to terminally ill cancer patients

Patients with incurable cancer are often not clearly informed of what they stand to gain from palliative chemotherapy, according to the study results published in BMJ Online First. As a result, British investigators say, patients may lack sufficient knowledge make a decision based on informed consent.

Palliative chemotherapy is not intended to cure patients of cancer, only to make their lives more tolerable. Nonetheless, this treatment may slightly improve survival.

Dr. Suzanne Audrey, at the University of Bristol, and colleagues observed and recorded 9 oncologists and 37 patients during consultations in which palliative chemotherapy for advanced lung, pancreas, or colon cancer was first discussed.

In all cases, patients were informed that their cancer could not be cured, and the purpose of palliative chemotherapy was explained. They were also informed about treatment options, common side effects and associated risks.

In 8 cases, survival was not discussed at all. In 18 cases, information was "vague," involving comments such as "about 4 weeks, a few months extra, and buy you some time." Only 6 patients were given numerical data about how much longer they would probably live if palliative chemotherapy were used.

"If the oncologist focuses on the benefits of palliative chemotherapy in terms of control of symptoms and quality of life, but omits information about survival benefit, the patient might assume much greater potential to prolong life than is likely to be the case," Audrey and colleagues suggest.

"Perhaps most difficult of all is when a patient, or their partner or carer, makes it clear that they do not want to receive any more bad news. Talking about life expectancy can seem cruel at this point," they continue. "But... supplying basic information about the survival benefit of treatment need not entail giving 'intrusive' data about prognosis."

Instead of evading the subject, the authors recommend that oncologists receive coaching on how to inform patients without taking away hope.

In a related editorial, Dr. Daniel F. Munday at Myton Hamlet Hospice in Warwick and Dr. E. Jane Maher at Mount Vernon Hospital in Middlesex urge researchers to investigate the dynamics of end-of-life consultations and to develop "decision aids" to help patients fully understand and interpret the information they are given.

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Unnecessary chemotherapy for leukemia patients

Nearly one-third of leukemia patients do not respond to chemotherapy, but this is not typically discovered until they have already endured a week-long course of chemotherapy and waited even longer to see if the chemotherapy worked.

A new study shows that positron emission tomography, known as PET scans, may tell doctors how well a leukemia patient is responding after just one day of chemotherapy.

"This has very profound implications for patients," Dr. Matt Vanderhoek told Reuters Health. "Instead of making the patient go through a week of chemotherapy only to find out after the fact that their chemotherapy wasn't successful, therapy could be modified and changed on the fly."

The University of Wisconsin researcher will present the research Thursday at the 50th annual meeting of the American Association of Physicists in Medicine, underway in Houston, Texas.

Treating leukemia typically involves killing the cancer cells where they originate in the bone marrow. Doctors traditionally take a bone marrow biopsy up to a week after the end of chemotherapy to see how well the cancer-killing drugs have worked.

"The problem with the bone marrow biopsy is that it is an insensitive and weak predictor of treatment response," Vanderhoek said. "A lot of patients will be told that their treatment was successful when in fact it wasn't. As a result you have a patient who has undergone a week of chemotherapy only to find out much later on that their treatment was unsuccessful."

In eight patients with a type of leukemia called acute myeloid leukemia (AML) undergoing a standard 7-day course of chemotherapy, Vanderhoek's team found that a PET scan using a PET radio-tracer called FLT obtained after only one day of chemotherapy can indicate whether or not the patient is responding to chemotherapy.

According to Vanderhoek and colleagues, brightness and non-uniformity in the bone marrow FLT PET scan was an indication that the patient was not responding to chemotherapy.

"We hope that this data will provide enough evidence for a larger study to reach more definitive conclusions" on the value of FLT PET in determining response to chemotherapy in leukemia patients, Vanderhoek said.

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