Patient‐hematologist discordance in perceived chance of cure in hematologic malignancies: A multicenter study

Abstract

Background Ensuring that patients with hematologic malignancies have an accurate understanding of their likelihood of cure is important for informed decision making. In a multicenter, longitudinal study, the authors examined discordance in patients' perception of their chance of cure versus that of their hematologists, whether patient‐hematologist discordance changed after a consultation with a hematologist, and factors associated with persistent discordance. Methods Before and after consultation with a hematologist, patients were asked about their perceived chance of cure (options were <10%, 10%‐19%, and up to 90%‐100% in 10% increments, and “do not wish to answer”). Hematologists were asked the same question after consultation. Discordance was defined as a difference in response by 2 levels. The McNemar test was used to compare changes in patient‐hematologist prognostic discordance from before to after consultation. A generalized linear mixed model was used to examine associations between factors and postconsultation discordance, adjusting for clustering at the hematologist level. Results A total of 209 patients and 46 hematologists from 4 sites were included in the current study. Before consultation, approximately 61% of dyads were discordant, which improved to 50% after consultation (P < .01). On multivariate analysis, lower educational level (<college vs postgraduate: odds ratio [OR], 2.24; 95% CI, 1.02‐4.92), higher social support–affection subscale score (1‐unit change in score: OR, 1.15; 95% CI, 1.00‐1.32), and discordance before consultation (OR, 6.17; 95% CI, 2.99‐12.72) were found to be significantly associated with discordance after consultation. Conclusions Patient‐hematologist concordance in prognostic understanding appears to improve after a hematology consultation, but approximately one‐half of patients' views of their prognoses were found to remain discordant with those of their hematologists. Interventions are needed to improve prognostic understanding among patients with hematologic malignancies.

Fear of Cancer Recurrence in Patients With Localized Renal Cell Carcinoma

“…Previous studies have shown that patients tend to harbor an inaccurate expectation of cure, and this may be associated with poor satisfaction with cancer care. [30][31][32] Several limitations should be noted. First, recruitment of patients through social media may have introduced bias, considering the high prevalence of women in this study despite RCC being more common in men than women.…”

Strategies for introducing palliative care in the management of relapsed or refractory aggressive lymphomas

“…Limited integration of primary and specialty palliative care for patients with aggressive lymphoma contributes to prognostic discordance between patients and hematologic oncologists and impairment in QOL. 7,8 Among several barriers to palliative care (Table 1), one that is amplified for patients with relapsed/refractory aggressive lymphomas is high prognostic uncertainty, given the potential of cure in relapsed settings and recent treatment advances. 25,26 For example, although the SCHOLAR-1 trial results were sobering with complete response and 24-month overall survival of 7% and 20%, respectively, for patients with refractory DLBCL, 27 complete response ranges from 40% to 58% with chimeric antigen receptor (CAR) T-cell therapy, 25,26 and the estimated 24-month overall survival is 50.5% for axicabtagene ciloleucel.…”

“…These patients have significant palliative care needs, including high physical and psychological symptom burden and impaired quality of life (QOL). [3][4][5] In addition, many harbor misunderstandings regarding their prognosis, [6][7][8] hindering their ability to engage in informed decision making regarding their care and end-of-life (EOL) preferences. Integrating high-quality palliative care is thus essential for this population; yet, existing evidence suggests suboptimal palliative care uptake.…”

Patient and caregiver agreement on prognosis estimates for older adults with advanced cancer

“…For the patient model, we prespecified the inclusion of patient age, sex, race, and education level, regardless of the significance level, based on prior literature demonstrating the association of these variables with prognostic estimates. 32,37,44,45 For the caregiver model, we prespecified the inclusion of caregiver age, sex, race, and education level, regardless of significance level, based on rationale similar to that used in the patient model. We considered 2-sided P values <.05 statistically significant based on the exploratory nature of this study.…”