What Goals Do Patients and Oncologists Have When Starting Medical Treatment for Metastatic Lung Cancer?

Abstract

It is unknown what treatment goals patients and oncologists have before starting systemic treatment. In total, 266 patients with metastatic lung cancer and their prescribing oncologists (n [ 23) were included. Patients and oncologist set quality of life, life prolongation, decreased tumor, and cure as treatment goals, but concordances of treatment goals were low. Clear communication about treatment goals should be integrated into clinical care. Background: Metastatic lung cancer is an incurable disease that can be treated with systemic therapy. These treatments might prolong survival and reduce symptoms, but they may also cause serious adverse effects. We studied the treatment goals of patients with metastasized lung cancer and their oncologists before starting systemic therapy, concordance between patients' and oncologists' goals, and feasibility of these goals. Patients and Methods: This research was conducted between November 2016 and April 2018 in 1 academic and 5 nonacademic hospitals across the Netherlands. A total of 266 patients with metastatic lung cancer and their prescribing oncologists (n ¼ 23) filled out a questionnaire about their treatment goals and the estimated feasibility of these goals before treatment was started. Additional interviews were conducted with patients and oncologists. Results: Patients and oncologists reported quality of life (respectively, 45% and 72%), life prolongation (45% and 55%), decrease in tumor size (39% and 66%), and cure (19% and 2%) as treatment goals. The interviews showed that the latter appeared to be often as motivation to stay alive. Concordances between patients' and oncologists' treatment goals were low (ranging from 24% to 33%). Patients had slightly higher feasibility scores than oncologists (6.8 vs. 5.8 on a 10-point scale). Educational level, age, religious views, and performance status of patients were associated with treatment goals. Conclusion: Patients and oncologists set various goals for the treatment they receive/prescribe. Low concordance might exist because different goals are set or because the patient misunderstands something. Clear communication about treatment goals should be integrated into clinical care.

Relatives of patients with metastatic lung cancer’s views on the achievement of treatment goals and the choice to start treatment: an interview study

“…respectively; oncologists: 96% and 93% respectively) in the previous study of Mieras et al 10 It is known that measuring satisfaction is not without problems. It holds the risk of creating a positive bias which could for instance be related by the desire to give social desirable answers or, according to cognitive dissonance theory, a tendency to assess one's situation or actions as good in hindsight.…”

“…Earlier we found that this was important for the patients and oncologists too. 10 It was also important for many relatives that the patient's wish for treatment was followed, even when sometimes they thought themselves the treatment might have gone on for too long. It is noteworthy that none of the positive aspects we found really resonated with aspects valued at the end of life that were found in a study by Steinhauser et al : 'pain and symptom management', 'clear decision making', 'preparation for death' and 'completion' valued at the end of life 8 .…”

“…[6][7][8] While patients and relatives attach great value to fulfilling these needs 8 , there is often hope for cure or life prolongation at the same time. 9,10 A few studies found the following treatment goals that patients mentioned before starting a treatment for metastatic lung cancer: to improve or maintain quality of life, to prolong life, get comfort, to fight cancer and cure [11][12][13] . Earlier we found that after treatment, patients reported in less than half of the time that these goals were achieved: quality of life for 30%, life prolongation for 49%, decrease tumour size for 26% and cure for 44%.…”

Patients with Metastatic Lung Cancer and Oncologists’ Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study

“…Systemic treatments such as chemotherapy, targeted therapy with tyrosine kinase inhibitors (TKIs), and immunotherapy are often initiated in patients with metastasized lung cancer despite the aggressive course, the incurability, and the possible side effects. 4–10…”

“…Goals that were mostly mentioned by patients in these studies are “quality of life,”“life prolongation,”“decrease of tumor growth,” and “cure”. 10–13…”