Know The Goals of Cancer Treatment
The goal of cancer treatment - whether it's surgery, radiation or chemotherapy - is usually described as curative or palliative.
Curative treatments are intended to get rid of the cancer. If the treatment is successful, the patient will be cured. Palliative treatments cannot cure the cancer. They are designed to either slow down the cancer (which can lead to a longer survival time), improve symptoms, or delay the onset of symptoms.
It is important to know whether treatment is meant to be curative or palliative, because that plays a major role in decision-making. But most patients aren't aware of the goals of their treatment.
Curative treatments are intended to get rid of the cancer. If the treatment is successful, the patient will be cured. Palliative treatments cannot cure the cancer. They are designed to either slow down the cancer (which can lead to a longer survival time), improve symptoms, or delay the onset of symptoms.
It is important to know whether treatment is meant to be curative or palliative, because that plays a major role in decision-making. But most patients aren't aware of the goals of their treatment.
The goals are often unclear to patients
In a study published in the New England Journal of Medicine, doctors surveyed about 1200 U.S. patients with incurable colorectal cancer or lung cancer who were receiving palliative chemotherapy. The large majority – 69% of lung cancer patients and 81% of colorectal cancer patients – weren’t aware that the treatment was not intended to cure the cancer.
Other studies have found similar results. In one example, doctors from Switzerland interviewed 71 lung cancer patients only a few days after they’d been told their diagnosis and the treatment recommendation. The patients were asked whether they remembered the diagnosis (lung cancer), the recommended treatment (e.g. surgery), or the goals of treatment (whether treatment was aimed at curing the cancer or not).
Patients did a good job of remembering the diagnosis and the recommended treatment – more than 80% got those answers right. But fewer than half of the patients remembered the goals of treatment.
Other studies have found similar results. In one example, doctors from Switzerland interviewed 71 lung cancer patients only a few days after they’d been told their diagnosis and the treatment recommendation. The patients were asked whether they remembered the diagnosis (lung cancer), the recommended treatment (e.g. surgery), or the goals of treatment (whether treatment was aimed at curing the cancer or not).
Patients did a good job of remembering the diagnosis and the recommended treatment – more than 80% got those answers right. But fewer than half of the patients remembered the goals of treatment.
Why should I know the goals?
If a treatment is intended to be curative, doctors will usually advise more aggressive therapies that maximize the chance of cure, even if they can have substantial side effects. In many cases those side effects would be temporary. A successful curative treatment could allow a patient to return to a normal life.
But if the treatment is intended to be palliative, there are more considerations. In this situation, patients are more reluctant to compromise quality of life. Patients are much less likely to accept an intensive treatment if there is a no chance of cure, compared to when there is even a very small chance of cure.
When doctors are surveyed about their own preferences if they had cancer themselves, similar patterns emerge, although the doctors tend to be less likely than patients to accept intensive treatment unless the chances of cure are higher.
If patients know the goals of treatment, then can make a good informed decisions. When deciding about any treatment, patients need to weigh the benefits of treatment against the risks. The potential benefits of treatment should always outweigh the risk. But if you don't know what the goals of treatment are, then you can't weigh the benefits against the risks.
Knowing the goals of treatment can help patients make better decisions.
But if the treatment is intended to be palliative, there are more considerations. In this situation, patients are more reluctant to compromise quality of life. Patients are much less likely to accept an intensive treatment if there is a no chance of cure, compared to when there is even a very small chance of cure.
When doctors are surveyed about their own preferences if they had cancer themselves, similar patterns emerge, although the doctors tend to be less likely than patients to accept intensive treatment unless the chances of cure are higher.
If patients know the goals of treatment, then can make a good informed decisions. When deciding about any treatment, patients need to weigh the benefits of treatment against the risks. The potential benefits of treatment should always outweigh the risk. But if you don't know what the goals of treatment are, then you can't weigh the benefits against the risks.
Knowing the goals of treatment can help patients make better decisions.
Should I ask for specific numbers?
"Doc, what are my chances?"
This is a common question from patients.
The medical word used to describe the chances of cure, or the expected outcome, is prognosis. Having a good prognosis usually means that there's a good chance of being cured.
Many patients, although not all, want to know their prognosis. But this is a very personal decision. Some patients prefer to be given a general idea (e.g. you will probably live a long time), others want very specific numbers, and roughly 10-20% don’t want to know at all. Telling patients their prognosis, when they want to know, doesn’t appear to be associated with increased sadness or anxiety, or worse patient-physician relationships.
Knowing your prognosis can have several advantages. It can allow for more realistic decision-making, and more appropriate use of health care services. Patients often make better decisions when they are well-informed and have realistic expectations.
This is a common question from patients.
The medical word used to describe the chances of cure, or the expected outcome, is prognosis. Having a good prognosis usually means that there's a good chance of being cured.
Many patients, although not all, want to know their prognosis. But this is a very personal decision. Some patients prefer to be given a general idea (e.g. you will probably live a long time), others want very specific numbers, and roughly 10-20% don’t want to know at all. Telling patients their prognosis, when they want to know, doesn’t appear to be associated with increased sadness or anxiety, or worse patient-physician relationships.
Knowing your prognosis can have several advantages. It can allow for more realistic decision-making, and more appropriate use of health care services. Patients often make better decisions when they are well-informed and have realistic expectations.
If you want to know your prognosis...
If you want an estimate of your prognosis, ask your doctor. You can also check some of the patient information websites that provide these numbers.
Keep in mind that any estimates of prognosis are just educated guesses. Survival numbers are just averages. Some patients do better than average, and unfortunately some do worse. That average might not apply to an individual. And doctors might over-estimate survival, especially in patients where the goals of treatment are palliative.
But a good estimate is a good place to start. Having an idea of your prognosis can help you to make good decisions about treatment and to plan for the future.
Keep in mind that any estimates of prognosis are just educated guesses. Survival numbers are just averages. Some patients do better than average, and unfortunately some do worse. That average might not apply to an individual. And doctors might over-estimate survival, especially in patients where the goals of treatment are palliative.
But a good estimate is a good place to start. Having an idea of your prognosis can help you to make good decisions about treatment and to plan for the future.