Elsevier

Clinical Oncology

Volume 24, Issue 2, March 2012, Pages 134-138
Clinical Oncology

Original Article
A Survey of Expectations and Understanding of Palliative Radiotherapy from Patients with Advanced Cancer

https://doi.org/10.1016/j.clon.2011.09.001Get rights and content

Abstract

Aims

: To assess patients’ understanding of their illness and expectations of palliative radiotherapy for symptomatic metastases before and after consultation and to explore the relationship between response and demographics/Edmonton Symptom Assessment Scale (ESAS) scores.

Materials and methods

In total, 100 participants completed a survey before and after consultation from March to October 2009. Descriptive statistics and statistical analyses were conducted to compare responses and to determine any relationship between responses and demographics or ESAS variables.

Results

Up to 25% believed their cancer was curable; there was no change in belief that radiotherapy would cure their cancer (17% before and 15% after) or prolong their life (40% before and 45% after). There were significant differences in radiotherapy expectation for symptom relief (P = 0.0094) and for patients who did not know the role of radiotherapy (P = 0.0025). Patient anxiety was reduced after consultation on questions about radiotherapy (P < 0.001), concerns on effectiveness (P < 0.0001) and side-effects of treatment (P < 0.0001); 96, 24 and 46% said after consultation that they were satisfied with information from the team, better understood their diagnosis of cancer and the role of radiotherapy, respectively.

Conclusion

A significant proportion of patients with advanced disease believe their cancer is curable, expect that radiotherapy will cure their cancer and prolong their life despite understanding the intent of radiotherapy is for symptom relief. After consultation, patients say they have a better understanding of their cancer and feel more confident about treatment. More work is needed to improve patients’ understanding of their illness and expectations of the role of palliative radiotherapy.

Introduction

Patient satisfaction is an integral component of quality of care, and is derived from the congruence between patients’ and their healthcare teams’ expectations of consultation and treatment [1], [2], [3]. A large proportion of cancer patients do not have a clear understanding of their disease prognosis [3], [4] or treatment [2], [3]. A survey conducted in 2001 revealed that 35% of patients with symptomatic metastases referred for a palliative radiotherapy consultation did not have a clear understanding of their illness and believed their cancer was curable. Furthermore, 20% expected palliative radiotherapy would cure their advanced cancer, and 38% believed treatment would prolong their lives, thus, rendering their expectations to be unrealistic [1].

Patient dissatisfaction or misunderstanding may influence patients’ preferences for treatment and potentially have a negative effect on quality of life [4], [5]. Patient dissatisfaction has been linked with non-compliance with medical advice, poorer coping [6] and pursuing more aggressive and potentially harmful treatment regimens [5].

To determine if patient expectations and understanding of their advanced cancer and radiotherapy treatment have changed over the past decade, a prospective patient-administered questionnaire was repeated both before and after consultation with the Rapid Response Radiotherapy Program (RRRP). The primary objective was to assess patients’ understanding of their illness and expectations of palliative radiotherapy to treat symptomatic metastases both before and after consultation with the RRRP. The secondary objective was to explore the relationship between response and demographics/Edmonton Symptom Assessment Scale (ESAS) scores.

Section snippets

Materials and Methods

After receiving the institution’s research ethics board approval, patients referred for palliative radiotherapy at the RRRP were prospectively asked to complete a survey consisting of 11 questions before and after consultation with their radiation oncologist. The survey items included the patient’s understanding of their illness, radiotherapy treatment, its aims and satisfaction with the information they were given before and after the radiation consultation. The following demographic

Results

Seventy-seven physicians referred 100 patients to the RRRP for a palliative radiotherapy consultation from March to October 2009. The median age was 66 years (range: 38–93). Fifty-six were men and 44 were women. The median KPS and current pain score for these patients were 70 (30–100) and 3 (0–10), respectively. Most patients had a primary cancer diagnosis of lung (38%), prostate (19%) or breast (17%). Concurrent chemotherapy, hormone therapy or any other concurrent therapy involved 15, seven

Discussion

This is the first study to document the change in patients’ understanding and expectations of their cancer and radiation before and after consultation with the physician and healthcare team in an outpatient palliative radiation clinic setting. A successful patient–doctor consultation is contingent on patient satisfaction [7]. Over the past decade, up to 35% of patients who present with advanced cancer continue to believe their illness is curable, and our prospective cohort was no exception [1],

Conflict of Interest

There are no conflicts of interest to declare with this manuscript.

Acknowledgements

We thank the Michael and Karyn Goldstein Cancer Research Fund, Dr A. Swaminath, R. Presutti, J. Nguyen, S. Culleton, L. Zeng and Stacy Yuen for assistance.

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