Cancer Patients View Their Prognosis Much Differently Than Physicians Without Ever Realizing It

While physicians and patients may be looking at the same prognosis, their expectations can differ tremendously. New research published in JAMA discovered that patient-oncologist discordance was common among the cases studied, and patients were unaware that their opinions differed from their physician’s.

Study researchers found that 68% of the study population rated their survival prognosis differently than the oncologist’s and in nearly all of these cases, the patient demonstrated more optimism for survival than did the oncologist. Only 1 in 10 of the 68% realized that their opinion differed. Additionally, nearly all of study participants said they wanted to be involved in the treatment decision process, and 70% of participants said they preferred supportive care, rather than aggressive therapy, at the end of their life. Though, the authors noted that making informed decisions means knowing when end of life is near.

Coauthor Ronald M. Epstein, MD, professor of Family Medicine, Psychiatry, and Oncology at the University of Rochester Medical Center, explained that while positive thinking can be beneficial to the patient and improve quality of life, a large disparity between the patient and the physician about life expectancy can be problematic.

“When people think they'll live a very long time with cancer despite evidence to the contrary, they may end up taking more aggressive chemotherapy and agreeing to be placed on ventilators or dialysis, paradoxically reducing their quality of life, keeping them from enjoying time with family and sometimes even shortening their lives,” said Epstein in a statement. “So it's very important for doctors and patients to be on the same page.”

Two hundred and thirty-six patients with either stage 3 or stage 4 cancer participated in the study, alongside the 38 oncologists who were treating these patients. Study participants completed a questionnaire in which oncologists were asked, “What do you believe are the chances that this patient will live for 2 years or more?” and the patients were asked, “What do you believe are the chances that you will live for 2 years or more?” Study authors also asked the patients whether or not they believed their prognosis opinions differed from their physicians’ and to what extent treatment options were discussed at the end of one’s life.

Researchers additionally found that discordance was significantly higher among nonwhite patients, though the number of nonwhite patients studied in this group was small and included various racial groups, limiting the study researchers from drawing further conclusions.

The research team concluded that differing opinions among patients and physicians about life expectancy, especially when both parties do not realize their opinions differ, is a sign of systematic miscommunication. The authors noted that talking about cancer prognosis can be difficult, as discussing this topic can be frightening and confusing. Therefore, continuing this conversation about personal values and treatment goals over several visits is highly recommended.