By Lynne Eldridge MD, About.com Guide / June 21, 2013
If you (or a loved one) are living with lung cancer, you’ve probably heard of radiation therapy as an option. If so, you wouldn’t be alone. Roughly 50% of people with lung cancer receive radiation therapy at some time during their journey. But what are your expectations from this treatment, and what has your doctor shared with you about its effectiveness?
A new study supports what a previous study found: What patients expect from a treatment, and what physicians expect, may be at odds.
Radiation therapy can be helpful for many people with lung cancer. It can often help with symptoms caused by the cancer (such as improving breathing or alleviating bone pain) and may prolong life. But it is not used as a way to cure cancer for people with metastatic cancer. (It’s important to note that in some cases, when used in early stage lung cancer, the goal may be curative.)
Researchers questioned patients with stage 3B and stage 4 lung cancer regarding their expectations from radiation therapy for their disease. 67% of these people felt that radiation therapy would likely help them with symptoms related to their cancer, and 78% believed that the treatment would likely help them live longer.
Where the disparity between physicians and patients was significant was in the intent to cure. 64% of the patients did not understand that radiation therapy was not at all likely to cure them. (92% of this group also had an inaccurate understanding about the long term benefit of chemotherapy.)
Patient-physician communication is obviously to blame for much of the disparity. While patients may not know the right questions to ask, physicians may also be hesitant to address this – after all, discussing how a treatment is not at all likely to be curative could be construed as removing hope, and we all know how important hope is. Surprisingly, in the earlier study noted above, patients who said they had good communication with their doctor were more likely to harbor false hope that a treatment could be curative.
I can understand the fear of removing hope. Yet I still believe it’s extremely important for patients to understand the limitations of treatment. Understanding preserves autonomy. And understanding allows people to look at options.
Options like what? Knowing that a treatment is unlikely to offer a shot at long-term survival, some people may choose to skip the treatment (and the side effects, traveling, time, and cost.) Or perhaps they would rather invest their resources in alternative therapies that may improve quality of life (but not extend it) – things such as acupuncture, qigong, yoga and meditation. Or, knowing what radiation therapy does or does not offer, perhaps they may wish to use their time and resources to check off something important on their bullet list – traveling to that destination of their dreams or reconciling with an estranged friend. These are just a few random ideas, but the point is that people with cancer are unable to brainstorm and lay out their options without a knowledge and understanding of what a treatment may or may not be expected to offer.
Once again I need to get off of my proverbial soapbox, but I have to share that personally, in my own cancer journey, I’ve had to be my own advocate. Nobody knows our bodies or our needs more than we do. And as a physician I’ll say again that even the brightest physician on the planet can’t know everything. Ask questions. Do a little research. Ask your doctor the hard questions and expect an honest answer. Make decisions based on what is best for you – not what your doctor or spouse or best friend would do. Cancer can take many things away from us, but we can still stand at the helm and dictate the course in our journey.
Chen, A. et al. Expectations About the Effectiveness of Radiation Therapy Among Patients With Incurable Lung Cancer. Journal of Clinical Oncology. 2013 Jun 17. (Epub ahead of print).