ASCO GI: When Oncologists Say Risk, Patients Hear Benefit

ORLANDO, Jan., 22 -- More that a third of colorectal cancer survivors surveyed said they would be willing to undergo a repeat course of highly toxic therapy for even a minuscule reduction in the risk of recurrence, researchers reported here.

Thirty-six percent of 150 colorectal cancer patients who had undergone surgery and chemotherapy within the previous five years said they would be willing to accept chemotherapy again to achieve a 1% absolute reduction in risk of recurrence, said Neil Love, M.D., president of Research in Practice, an oncology education company in Miami.

What's more, he reported at a gastrointestinal cancer symposium here, 57% of patients said they would willingly agree to another course of chemotherapy if it guaranteed a 3% absolute reduction in risk of recurrence.

But when Dr. Love asked 150 medical oncologists to predict how many patients would be willing to repeat chemotherapy for a 1% reduction in risk of recurrence, it was a different story. The oncologists estimated that only 19% of their patients would agree to the toxic re-treatment.

"This survey demonstrates that patients may be far more willing to receive cytotoxic therapy for what other might view as modest potential treatment benefits," Dr. Love said.

The finding points out a problem that has no easy solution, he said, adding that, "when a patient receives a diagnosis of cancer, something happens to that person that people who are not patients-including oncologists--do not fully understand."

Nonetheless, he said his findings "underscore the importance of better communication between physicians and patients to ensure that physicians clearly understand patient expectations regarding treatment, and so that patients receive clear and accurate information about the risks and benefits of therapy."

Dr. Love also surveyed the patients about their expectations concerning cancer treatments and about their source of information about their disease.

In general, he said, "colorectal cancer patients are receiving their information about cancer treatments from the Internet and from friends or relatives." In both instances the information was often wrong or incomplete, he said.

For example, "many patients based their expectations about hair loss, nausea, and vomiting on what they had heard about breast cancer chemotherapy, but the toxicities are much different for colorectal cancer treatments," he said.

As a result, two thirds of the patients, all of whom had undergone Eloxatin (oxaliplatin)-based regimens, said that hair loss was not as bad as they anticipated and 57% said that nausea or vomiting was not as bad.

By contrast, 46% said that numbness in the fingers and toes was worse than they had expected and 38% said cold intolerance was worse.

Dr. Love said that indicated the need for oncologists to "take the time to ask patients if they have been researching their condition or discussing treatments with family, friends, or in chat rooms."

At that point, the oncologist can discuss what the patient has learned and help the patient interpret that information in way that would be relevant to the patient's disease state.

"The study certainly sensitizes us to be careful to devote time and describe the benefits and risk of various treatments to our patients," commented Robert Mayer, M.D., of Harvard Medical School and the Dana-Farber Cancer Institute. Dr. Mayer was not involved in the study.

Dr. Love disclosed that he was a consultant or has acted as an adviser to Access, Amgen, Bayer, BioGen IDEC, Bristol-Myers Squibb, Genentech, Genomic Health, ImClone Systems, Merck, Novartis, Pfizer, Response Genetics, Roche, sanofi-aventis, and YM Bioscience; that he owns stock in Genentech; has received honoraria from Bristol-Myers Squibb, Genentech, ImClone, Pfizer, Roche, sanofi-aventis; and research funding from Amgen, Bristol-Myers Squibb, Celmed, Eisai Medical Research, Genentech, ImClone Systems, Novartis, Pfizer, Roche, sanofi-aventis and Taiho.

The Gastrointestinal Cancer Symposium was jointly sponsored by the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, the American Gastroenterological Association Institute, and the Society of Surgical Oncology.