Significant Disagreements Among Patients With Blood Cancers and Oncologists Persist Regarding Prognosis and Goals of Care

There is a difference between patient and oncologists regarding prognosis, and patients are lacking understanding of prognosis and interventions needed to help them make more informed treatment choices.

There is a significant difference between how patients with leukemia or multiple myeloma and their oncologists understand prognosis and goals of care, according to data published in Cancer.

The researchers noted that this disparity highlights the need for interventions to improve patients’ understanding of prognosis.

Previous studies have revealed patients with hematologic malignances have a lack of illness understanding and prognostic awareness. To look further into this, researchers of the current study sought to discover and compare survey answers from 60 patients with either acute myeloid leukemia (30 patients) or multiple myeloma (30 patients). The study also included answers from 15 oncologists. Patients completed a survey with questions about prognostic awareness, goals of care and quality of life, and oncologists received a similar survey for each patient.

“Oncologists’ responses often corresponded to a patient’s line of treatment or risk group, whereas patients’ responses did not correlate with disease-specific factors,” the study authors wrote.

Across the entire group, patients were overall more optimistic about treatment goals compared to oncologists. In addition, oncologists were significantly more optimistic about then line of treatment compared to patients. Survey responses indicated that there was a significant difference about a patient’s treatment goal and likelihood of a cure for their cancer, prolonging life with treatment and reduced suffering from treatment.

In pairs of patients and oncologists, there was a significant difference in beliefs about current disease, life expectancy and likelihood of prolonging life with treatments. There was some agreement about treatment goals and likelihood of a cure for their cancer, as well as slight agreement on likelihood of reduced suffering from treatment.

Researchers also note that there was a significant difference regarding life expectancy, with 39 patients (65%) responding “don’t know” or deferring to a faith-based response such as “in God’s hands/up to fate” compared with 18 oncologists (30%).

This study has several limitations including the number of patients in the study, patients completing the survey at different times throughout their hospitalization, lack of questions regarding the patient-oncologist relationship and that the study was only conducted at one institution.

“This study shows a gap in an important area of patient-oncologist communication, and this discordance can impair patients’ ability to make informed treatment choices that align with their values and preferences,” the study authors concluded. “These data support the need for an intervention to enhance psychological support in the patient population with acute leukemia and multiple myeloma to increase prognostic understanding, emphasize (goals of care) discussions and improve (quality of life).”

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