Seeing Things Differently
Just in case there is anyone out there who reads these blogs daily, I will begin by explaining that yes, I know this is the second entry today. However, I have to get up very early tomorrow morning and head immediately to the airport, spend most of the day on a plane, and it seems wiser to write tomorrow's entry this evening.
We all know that physicians and patients see things differently. What we don't really know is how differently and which things and are there ways to modulate the differences and find common ground. This is a really interesting report on a study by A.Sheik-Yosouf and colleagues at the University of Toronto about perspectives on the treatment of metastatic (Stage IV) breast cancer. I have long known that women and their doctors are often not on the same page about treatment in this situation and that women are often not fully informed of possibilities, risks, and benefits.
Here is the study:
7th European Breast Cancer
Barcelona, Spain, 24-27 March 2010
Abstract 63: A comparison of physician and patient perceptions of clinically important endpoints in the treatment of Metastatic Breast Cancer (MBC)
Citation: European Journal of Cancer Supplements Volume 8, No.3, March 2010,
page 77 A. Sheik-Yousouf1, S. Gandhi2, S. Dukhovny1, S. Verma2
1University of Toronto, Department of Medicine, Toronto Ontario, Canada
<>2University of Toronto Department of Medical Oncology, Sunnybrook Odette Cancer
Centre, Toronto Ontario, Canada
Background: To examine and compare the clinical trial endpoints physicians and patients consider to be important in MBC treatment decision making, amongst a cohort of Canadian oncologists and patients.
Methods: 28 breast oncologists responded to a secure, anonymous, and self-administered online survey. 52 Patients with MBC were also surveyed through a self-administered paper survey. Results were assessed using descriptive statistics.
Physician results: In the first line MBC setting, 52% believed overall survival (OS) was the most important endpoint considered in choosing a specific therapy, and 48% believed progression-free survival (PFS) was the most important. 48% thought that a minimum meaningful incremental improvement in OS from a first line MBC therapy was 4-6 months, and 44% believed 2-4 months was meaningful. 60% of oncologists believed that their patients also consider improvement in OS to be the most important endpoint, and 36% believed that overall QOL is the second most important factor to patients with MBC.
Patient results: The vast majority of patients believed the primary goal of their treatment(s) was to prolong life (88%). 63% also believed slowing tumour growth was a goal of treatment; shrinking tumour burden, and improving quality of life were also considered goals of treatment according to 62% of patients. 50% felt improving symptoms and pain were important therapeutic goals. 54% of patients believed prolonging survival was the most important endpoint in accepting MBC therapy, and 17% thought shrinking tumour size was the most important. In considering a new treatment for MBC compared to standard options, 46% of patients thought more than 12 months was the minimum improvement in overall survival (OS) they would consider as making the treatment worthwhile, 17% thought 10-12 months was acceptable, and another 10% thought only 1-2 months would be a minimal acceptable improvement in OS.
Conclusions and Discussion: Over half of patients and physicians surveyed consider OS as the most important endpoint in accepting therapy for MBC. However, physicians appear to consider much smaller absolute improvements in OS and PFS (2-6 months) as significant enough to adopt therapies, while almost half of patients required a greaterthan 12 month improvement in OS to consider a treatment worthwhile. This study is limited by small response numbers. Nonetheless, the data highlights disparities between oncologists and patients in the relative ranking of defined therapeutic endpoints, and in MBC treatment expectations. It thus emphasizes the ongoing need for thorough discussion of treatment goals with patients and for clinical trials to bring about meaningful results to both patients and physicians alike.