Relationship Between Perceptions of Treatment Goals and Psychological Distress in Patients With Advanced Cancer

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  • 1 Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center,
  • 2 Harvard Medical School, and
  • 3 Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, Massachusetts; and
  • 4 Department of Medicine, Section of Palliative Care, Stanford University, Stanford, California.
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Background: Studies have shown gaps in prognostic understanding among patients with cancer. However, few studies have explored patients’ perceptions of their treatment goals versus how they perceive their oncologist’s goals, and the association of these views with their psychological distress. Methods: We conducted a cross-sectional study of 559 patients with incurable lung, gastrointestinal, breast, and brain cancers. The Prognosis and Treatment Perception Questionnaire was used to assess patients’ reports of their treatment goal and their oncologist’s treatment goal, and the Hospital Anxiety and Depression Scale was used to assess patients’ psychological symptoms. Results: We found that 61.7% of patients reported that both their treatment goal and their oncologist’s treatment goal were noncurative, whereas 19.3% reported that both their goal and their oncologist’s goal were to cure their cancer, 13.9% reported that their goal was to cure their cancer whereas their oncologist’s goal was noncurative, and 5% reported that their goal was noncurative whereas their oncologist’s goal was curative. Patients who reported both their goal and their oncologist’s goal as noncurative had higher levels of depression (B=0.99; P=.021) and anxiety symptoms (B=1.01; P=.015) compared with those who reported that both their goal and their oncologist’s goal was curative. Patients with discordant perceptions of their goal and their oncologist’s goal reported higher anxiety symptoms (B=1.47; P=.004) compared with those who reported that both their goal and their oncologist’s goal were curative. Conclusions: One-fifth of patients with incurable cancer reported that both their treatment goal and their oncologist’s goal were to cure their cancer. Patients who acknowledged the noncurative intent of their treatment and those who perceived that their treatment goal was discordant from that of their oncologist reported greater psychological distress.

Submitted August 17, 2019; accepted for publication December 16, 2019.

Author contributions: Study concept and design: All authors. Data acquisition, analysis, and/or interpretation: All authors. Manuscript preparation and critical revision: All authors.

Disclosures: Dr. Greer has disclosed that he has received grant/research support from and consulting fees from Gaido Health/BCG Digital Ventures. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Dr. El-Jawahri has disclosed that she is a scholar in clinical research for the Leukemia and Lymphoma Society. Dr. Temel has disclosed that she receives funding from NCI (K24 CA181253).

Correspondence: Areej El-Jawahri, MD, Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Yawkey 7B, Boston, MA 02114. Email: ael-jawahri@partners.org
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