In a report in JAMA Network Open this year, among people age 70 and older being treated for incurable cancer, 41% believed they had more than five years to live — but only 10% of their oncologists agreed with their estimates. And nearly 60% of patients believed their terminal cancer could go away and never return.
Unrealistic expectations fueled by direct-to-consumer pharmaceutical advertising depicting happy cancer survivors and the pharma industry’s influence on oncologists hang over patient-doctor conversations. For every truly game-changing new drug or treatment indication, dozens of others offer just days or weeks of additional survival — if any — but at additional costs of hundreds of thousands of dollars and false hope.
Overconfidence in drugs is one reason doctors don’t talk more about services that do improve both the quality and quantity of life with their patients with advanced and terminal cancer, such as early palliative care. A 2021 survey of oncologists showed that just 17% follow guidelines that recommend they refer a patient diagnosed with metastatic disease to palliative care — and these same oncologists acknowledged that early introduction of palliative care leads to better patient outcomes. The reasons for this gap include perceived patient resistance, lack of time, and insufficient tools to educate patients.
Those defenses can’t be acceptable. Physicians should be responsible for overcoming health literacy barriers, time constraints, and mistrust to ensure that their patients understand all available options. Anything outside of that is not informed consent.
