Patient–Oncologist Prognostic Discordance Highlighted

Advanced cancer patients and their oncologists often disagree on 2-year survival prognosis

medwireNews: Patients with advanced cancer frequently, and unknowingly, have a different opinion on the likelihood they will survive for at least 2 years to that of their oncologists, research suggests.

The study of 236 patients with advanced cancer and their 38 oncologists showed that 2-year prognostic discordance occurred in 68% of cases, with 96% of these patients giving a more optimistic outlook than their oncologist.

The majority (89%) of the 161 patients with prognostic discordance did not know that their opinion differed from that of their oncologist, although 29% stated they did not know what their oncologist’s opinion on 2-year survival was.

However, the participating oncologists recalled having “completely thorough discussions about prognosis” with 52% of the discordant patients, say Robert Gramling, from University of Vermont Medical Center in Burlington, USA, and co-workers.

Closer analysis indicated that non-White patients were “substantially” more likely to have prognostic discordance than their White counterparts (95 vs 65%) and not be aware of the discordance (91 vs 62%). And these relationships were not “substantively changed” after adjusting for other potential confounding factors such as age, income or aggressiveness of cancer type.

Of concern, 99% of the discordant patients stated they wished to be involved in treatment decision-making, 70% of whom said they would definitely or possibly like to include palliative care near the end of life. 

“We propose that this unknowingly discordant status is a marker, at least on average, for inadequate patient-physician communication about a topic of high relevance to treatment decision making in advanced cancer”, the study authors conclude in JAMA Oncology.

“Therefore, this study supports the urgent clinical and societal need to better understand what it means to communicate well about prognosis to achieve treatment that honors patients’ values, preferences, and wishes.”

The authors of an accompanying editorial agree that the study “provides clear evidence of the ongoing need for improved communication in the context of advanced cancer.”

“After all, promoting more realistic prognostic estimates is a critical step toward improving patients’ quality of life and preference-concordant illness management decisions, including the reduction of overly aggressive treatments that many patients will otherwise continue to receive”, write Jeffrey Robinson, from Portland State University in Oregon, USA, and Reshma Jagsi, from the University of Michigan in Ann Arbor, USA.

References

Gramling R, Fiscella K, Xing G, et al. Determinants of patient–oncologist prognostic discordance in advanced cancer. JAMA Oncol 2016; Advance online publication 14 July. doi:10.1001/jamaoncol.2016.1861

Robinson JF, Jagsi R. Physician-patient communication–an actionable target for reducing overly aggressive care near the end of life. JAMA Oncol 2016; Advance online publication 14 July. doi:10.1001/jamaoncol.2016.1948

medwireNews (www.medwireNews.com) is an independent medical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2016