While research shows there is a long way to go to successfully making palliative care part of standard care for patients with advanced cancer treated at cancer centers across the U.S., a new study reveals there is an even longer road ahead when it comes to making palliative care a global standard of cancer care.
The main goal of the new research was to look at the characteristics of patients receiving palliative care that were associated with a poor perception of curability, explained the study's lead author Sriram Yennu, MD, MS, Associate Professor in the Department of Palliative Care and Rehabilitation Medicine in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, Houston.
“This was the first study that had the presentations from so many different continents,” he said. The research was presented at this year's Palliative Care in Oncology Symposium and analyzed data from 1,390 patients with advanced cancer receiving palliative care from countries in North and South America, Europe, Asia, and Africa (Abstract 05). Among all of the patients, 49 percent reported that their cancer was curable, 60 percent perceived the goal of their therapy was “to get rid of their cancer,” 79 percent perceived that the goal of their therapy was to “make them feel better,” and 62 percent perceived they were relatively healthy.
Additional analysis revealed the patients from France and South Africa were more likely to have an accurate perception of the goal of their treatment, while patients from the Philippines, Brazil, and Jordan were more likely to have the misperception that the goal of their treatment was to cure their cancer. What's more: these regional differences were more significant in explaining the gaps in the patients' misperceptions about the curability of their cancers than age, gender, marital status, religion, and passive decision control preferences.
In an interview with Oncology Times, Yennu elaborated on what these findings mean and how the researchers plan to use the new data.
1 What would you say are the key findings from this research? And were you surprised by the findings?
“Many advanced cancer patients have confusion. They have poorly answered questions regarding their disease, treatment goals, and decision-making.
“The main goal [of our study] was to look at the patient characteristics associated with a poor perception of curability.
“We found there was a really significant role of culture in how patients perceive the curability of their cancer and the goals of their treatment.
“Patients belonging to countries such as the Philippines, Brazil, and Jordan had a poor perception of curability, and patients belonging to countries such as France and South Africa had more accurate perceptions of curability, compared to the United States. Interestingly, age and marital status, religion, and the way they are making decisions showed no significant [role] in patients' perception of curability.
“Education, which is a surrogate for socioeconomic status, [also played a role in patients' perception about their disease]. Patients who were highly educated (having a college or advanced degree) were more likely to have an accurate perception of the goals of their palliative care compared to others who had a high school education or less.
“But what exactly causes people to have these varying perceptions about their cancer and care is not clear from the results of this study. We need further studies to investigate what is modulating what.”
2 What should practicing oncologists (in any country) know about this research?
“Communication—patient-physician communication—is a really critical aspect of what physicians do in the management of the disease. That includes reviewing different treatment regimens and the traditional approach, discourse about the disease, and the goals of therapy to help patients get the appropriate treatment.
“Asking a patient what they understand about the perception of curability is the first step physicians need to do to help that patient.
“Then they need to explain what the goals for therapy are. And once that is explained, we need to reiterate during subsequent visits all of those points.”
3 How will you continue this research? What are the next steps?
“The questions that were answered were very straightforward. The next step would be doing some qualitative studies to understand why this is and developing a grounded, theoretical framework so that we can develop interventions using modalities like decisional aids and checklists to help patients have the correct perception of curability—and thereby help them make the right decisions.”