Majority of Lung, Colorectal Cancer Patients Believe Surgery Curative

Large proportions of lung and colorectal cancer patients believe that surgery will cure their cancer, according to results of a new population-based study. Even those with stage IV disease often believe surgery will be curative, suggesting that better patient-physician communication is needed.

Authors led by Yuhree Kim, MD, MPH, of Johns Hopkins University School of Medicine in Baltimore, wrote that establishing the goals of care is always important, but particularly so for surgery. “Surgery has great potential to alleviate symptoms, as well as to extirpate disease in the hopes of obtaining long-term cure,” they wrote. “However, surgery can also be associated with morbidity, mortality, worsening of quality of life, and considerable health care expense.”

The new study aimed to characterize patient perceptions of surgery; it included 3,954 patients who underwent cancer-directed surgery for lung (30.3%) or colorectal (69.7%) cancer; they were participants in the Cancer Care Outcomes Research and Surveillance Consortium. Results were published in Cancer. Most of the patients included had early-stage disease (stage I/II, 61.6%); 25.9% had stage III disease and 12.5% had stage IV disease.

Among lung cancer patients, 959 (80.0%) said that surgery was “very likely” or “somewhat likely” to cure their cancer. Among colorectal cancer patients, the rate was even higher, at 89.7%. Forty percent of lung cancer patients with stage IV metastatic disease said it was “very likely” that surgery would cure the disease, and another 17.4% said it was “somewhat likely.” For colorectal cancer, these rates were 48.8% and 31.0%, respectively.

The authors used a multivariate analysis to determine the influence of a variety of factors on the perception of a likelihood of cure. Patients who were female were less likely to perceive that surgery would cure the disease, with an odds ratio (OR) of 0.79 (95% confidence interval [CI], 0.72–0.86; P < .001); unmarried people also had a lower likelihood. African American and Asian American patients, meanwhile, were more likely to say that surgery was likely to cure their disease. Education and income levels were not significantly associated with these perceptions.

In the full cohort, 55.6% of patients rated communication with their physician as “optimal.” On multivariate analysis, those who rated communication as optimal were more likely to perceive a surgical cure possibility, with an OR of 1.89 (95% CI, 1.70–2.11; P < .001).

“In light of established prognostic information, data from the current study suggest that there are patient misperceptions regarding the benefits and prognosis associated with surgery,” the authors wrote. “The reasons for these misperceptions are undoubtedly multifaceted and likely involve, to some degree, patient-physician communication.”