What are waiting for patients with American metastatic cancer from their cancer treatment? Most often, they desire a good quality of life, according to a large and rare survey on the subject in this patient population.

Jeremy DeMartini, MD, Department of Psychiatry, University of California, Davis and colleagues in a new study, said that Cure was not even among the top five responses among the 216 participating patients. published in the January issue of Diary of pain management and symptoms.

The most common hope (42% of total responses) was to maintain the quality of life.

The extension of life (32%) was ranked second, followed by tumor stabilization (26%), remission (20%), reaching a milestone (14%), %), and "unreserved" healing (12%). Another five percent hoped for a treatment "tempered by realism" (for example, hoping for treatment, but admitting it was not possible). Thus, even if the two categories of treatment were combined, they still accounted for only 17% of the hopes expressed by the patients.

However, the new study presents an important caveat: the survey was part of a trial conducted from 2012 to 2014, before immunotherapy received widespread publicity – and hype – about the Improved survival and possible treatment of patients with advanced cancer.

In short, the survey data can be dated, to a certain extent.

Times have changed, acknowledged DeMartini in an email to Medscape Medical News.

"Immunotherapy and the promise of other new treatments for many types of cancer give hope to patients and doctors," he said.

Clinicians wishing to put into practice the findings of the survey may have difficulty, suggested Bishal Gyawali, MD, PhD, of Brigham and Women's Hospital in Boston, in a comment posted on his site. Twitter feed on the new results.

Indeed, in terms of substance abuse treatment, the quality of life is not well documented, said Gyawali, who did not participate in the study.

"Unfortunately, nearly half of cancer drug trials do not even include quality of life and a quarter of them will not report it," he tweeted. citing a 2018 study.

However, the authors of the study do not discuss this failure.

DeMartini said that anticancer drugs "are not devoid of side effects" and that patients with advanced cancer and their doctors must balance the risks and benefits associated with it.

The authors say that "little is known" about the hopes of treating patients with advanced cancer.

Other studies on the subject have had shortcomings, they say, citing reduced-size samples, the inclusion of patients with serious diseases other than advanced cancer and the inclusion of pennies – sets of types of cancer.

When asked if the lack of substantial data was a surprise given the importance of the question, DeMartini replied, "Yes!"

Authors concerned about hopes of recovery

The new study comes from the VOICE trial, a communication study with the patient. The researchers interviewed 265 patients from the University of Rochester and the University of California at Davis; these patients had a variety of advanced cancers, 50% of which were classified as "aggressive".

After 3 months, 45 patients died and four dropped out of the study, leaving 216 patients for the final results.

Initially, the investigators aroused the hopes of patients during interviews. They asked the following open question: "What do you hope … in your cancer treatment?"

Subsequent interviews at 3 months gave another set of responses, but the relative prevalence of responses "has not changed substantially" from the start, say the authors.

In other words, the quality of life remained the main hope of the second interview. And the cure was still deep.

Study sites are one of its limitations. The authors explain: "Our findings may not be generalized to the entire population of patients with advanced cancer because patients were recruited in only two geographic areas and the sample was mainly white, christian and educated. "

The study used open interviews, which the team transcribed and analyzed. As noted above, this has resulted in eight categories of hope in which 95% of patients' responses could be categorized at both baseline and three months.

The study also asked patients about the discussions they had had about their hopes for cancer treatment and with whom they had discussed these hopes.

Most patients reported discussing their treatment hopes with their partners, family / friends and oncologists. A minority said they discussed their hopes with nurses, primary care physicians, clergy or support groups.

In the logistic regression analysis, the authors are more likely to find a cure for the youngest patients and those who did not talk about their hopes with their primary care physician.

DeMartini explained, "Although primary care physicians do not typically treat cancer directly, they can maintain a long-standing, comprehensive relationship with the patient that is helpful in centering or redefining their hopes."

The authors of the study hope that clinicians will question patients about their hopes of treatment – in order to cope with the likely reality. The authors repeatedly express their concern about the "significant minority" of patients who express hope for treatment, despite metastatic disease.

The study was funded by the National Cancer Institute. From Martinini, his co-authors and Gyawali did not reveal any relevant financial relationship.

Diary of pain management and symptoms. Posted online January 2019. Full Text

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