Talking about Life Expectancy with Our Cancer Patients Considering Palliative Chemotherapy
- Pp. 366-375 (10)Kikuo Nakano
When making decisions about palliative chemotherapy, patients require information on how the cancer and its treatment will affect their life expectancy. To properly communicate this information, truthful and honest conversations about a patients’ prognosis and the goals of treatment are essential, because any misunderstanding about the intent of treatment may lead to requests for ineffective or futile treatment. However, these conversations are inherently difficult due to a low confidence in an oncologist’s ability to prognosticate accurately and fear of destroying hope or provoking emotional distress. There are few studies or guidelines for oncologists in estimating and explaining life expectancy in a way that conveys meaning without destroying hope. A recent study has demonstrated that providing estimates for worst-case, typical and best-case scenarios for survival are a helpful way of communicating life expectancy while conveying hope, and that the percentiles from an overall survival curve in first-line chemotherapy trials for advanced non-small cell lung cancer (NSCLC) can provide accurate estimates of the three scenarios. Furthermore, the initiation of establishment of illness understanding and discussing patients’ goals for treatments of metastatic NSCLC earlier in the course provides a more accurate assessment of their prognosis, depression and survival. Additionally, decision aids (DAs) in the setting of advanced colorectal cancer and palliative chemotherapy has shown that the use of DAs improved patient understanding of prognosis, treatment options, risks, and benefits without increasing anxiety. This review explores communication issues when talking about life expectancy with our cancer patients participating in palliative chemotherapy.