Further Patient Education by Clinicians Is Necessary to Facilitate Better Decision Making

Only around half of survivors and patients with lung cancer reported knowing what their treatment options were before making a decision about treatment, although consensus indicates that most felt they were involved in the decision-making process, according to results from a study presented at the 2020 World Conference on Lung Cancer Singapore.

In addition, few patients reported feeling prepared to discuss options with their doctors, and many patients wanted more support prior to making a treatment decision, according to a virtual presentation on the findings.

“With recent advances in early detection of lung cancer, biomarker testing and personalized treatment planning, effective patient-provider communication is more important than ever for short- and long-term survivorship,” said Kelly Clark, MA, research manager at the Research and Training Institute at Cancer Support Community in Philadelphia, during the presentation. “Open communication between patients and clinicians about treatment options and cancer experience is a critical step toward collaborative treatment decision making.”

Researchers assessed responses from 276 patients (mean age, 61.8 years; 67% women; 86% White) with lung cancer in the Cancer Support Community’s Cancer Experience Registry, “an online survey open to any adult ever diagnosed with cancer,” Clark explained. Patients in this study answered additional questions about their lung cancer diagnosis and treatment decision making.

Of the patients in this study, 82% had non-small cell lung cancer. The mean time since diagnosis for all patients was three years. In addition, 23% had cancer recurrence and 39% had metastatic cancer. With regards to treatment, 76% underwent chemotherapy and 28% received immunotherapy. More than half of the patients in this study — 58% — were currently undergoing treatment.

With regards to treatment decision making, 67% of patients reported that they were quite a bit, or very much, involved in the process compared to 33% who reported they were somewhat or not at all involved. In addition, 34% reported being quite a bit or very knowledgeable about their treatment options before going through the treatment decision-making process versus 66% who were somewhat or not at all knowledgeable about their options.

Findings also determined that 38% of patients would have liked more support before treatment decision making compared with 42% who did not feel that they needed more support. Sixty percent of patients were somewhat or not at all prepared to discuss treatment options with their doctor compared with 40% who reported they were quite a bit or very much prepared to do so.

Preparation to discuss treatment options with the doctor was positively correlated with involvement in the treatment decision-making process (r = .52; P < .001) and knowledge about treatment options (r = .51; P < .001). Patients with income greater than $40,000 were more likely to be more prepared, have more knowledge about treatment options and were more involved in the treatment decision-making process compared with those with an income less than $40,000.

“(This is) suggesting that those with lower income may have less access to treatment decision-making resources compared to their economically advantaged counterparts,” said Clark during the presentation.

There was a small yet statistically significant difference regarding sex and preparation for treatment option discussions with their doctor. Women were more likely than men to report feeling prepared for these discussions (t = 2.69; P < .01). In contrast, treatment decision-making factors did not differ by race, age and lung cancer subtype.

“Results suggest involvement alone is insufficient for an informed treatment decision-making experience and highlight a need for additional resources such as treatment decision-making guides or in-person counseling to enhance health care team communication surrounding treatment decision making for individuals with lung cancer, particularly for economically disadvantaged individuals. Such efforts may provide patients better knowledge about treatment options, thus enhancing their preparation to discuss and select the appropriate treatment pathway,” Clark concluded.

Reference:

Kranzler EC, Fortune EE, Miller MF, et al. Treatment Decision-Making and Decisional Support Experiences Among Lung Cancer Patients and Survivors. Presented at: 2020 World Conference on Lung Cancer Singapore; January 28-31, 2021; virtual. Abstract FP06.02.