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Vol.53 No.6 contents | Japanese/English |
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- Original Article -
Relationship Between Misunderstandings Regarding the Prognosis and Goals of Chemotherapy in Patients with Advanced Non-small-cell Lung Cancer and End-of-life Outcomes
Kikuo Nakano1, Takashi Yoshida1, Yoshihiro Kitahara1, Yuhsuke Araki11Department of Respiratory Medicine, National Hospital Organization Kure Medical Center, Japan
Objectives. This study aimed to explore the perceptions of the prognosis and goals of chemotherapy and to evaluate the differences in end-of-life outcomes between advanced non-small-cell lung cancer (NSCLC) patients with accurate perceptions and those with inaccurate perceptions. Methods. This was a longitudinal cohort study. A questionnaire regarding curability and eliminating all cancer was administered to 36 patients with advanced NSCLC who received at least first-line chemotherapy. The outcomes, including chemotherapy use and location of death, were also longitudinally assessed according to accurate or inaccurate perceptions of the prognosis and goals of chemotherapy. Results. The patients' perceptions were assessed at a median of 17.7 months from the initiation of chemotherapy. Fifty-six percent of the patients reported that their cancer was incurable. Only 38% of the patients answered in concordance with the perceptions that their cancer was not curable and that the goal of chemotherapy was not to eliminate all of their cancer. Among the 19 patients who died during follow-up, the median number of days between the last dose of chemotherapy and death and the overall survival did not differ significantly between the patients with accurate perceptions and those with inaccurate perceptions. The patients with accurate perceptions were more likely to discuss their wishes for chemotherapy discontinuation with a physician (64% versus 38%) compared with those with inaccurate perceptions. Moreover, the patients with accurate perceptions were more likely to die in a palliative care unit (31% versus 0%, P=0.055) than those with inaccurate perceptions. Conclusions. Many patients with advanced NSCLC may misunderstand their prognosis and the goals of chemotherapy, which leads to inappropriate decision-making regarding end-of-life care.
key words: Patients' perceptions, Prognosis, End-of-life care decisions, Chemotherapy, Advanced non-small-cell lung cancer
Received: June 18, 2013
Accepted: August 20, 2013
JJLC 53 (6): 745-750, 2013
