Clinicians ‘nihilistic’ toward lung cancer patients

Dec 3 2013

By Joanna Lyford, Senior medwireNews Reporter

Clinicians tend to view their lung cancer patients more negatively than patients with other solid tumors, study findings indicate.

Specifically, clinicians considered patients with lung cancer to be more difficult to treat, have a poorer quality of life, and a greater symptom burden than other cancer patients, and these negative perceptions persisted even when unsupported by objective evidence.

“[B]y suggesting a subtle, potentially real, underlying bias and nihilism, these findings are provocative and should be further investigated for confirmation and exploration of their underpinnings,” write Heidi Hamann (University of Texas Southwestern Medical Center, Dallas, USA) and co-authors in the Journal of Thoracic Oncology.

Hamann’s team analyzed data on 3106 patients with solid tumors who had participated in the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study. The tumor site was lung in 17%, breast in 50%, colorectal in 23%, and prostate in 10% of patients.

Analysis of patient assessments found that lung cancer patients rated their quality of life as significantly worse and their symptoms as more severe than patients with any of the other tumor types.

Meanwhile, clinicians were approximately five times more likely to report difficulties in caring for patients with lung cancer as those with other diseases. Clinicians were also 3.6 times more likely to perceive a poor quality of life and 3.2 times more likely to perceive weight difficulties in patients with lung cancer than in those with other tumors.

Notably, these disease-site effects persisted after accounting for variables such as tumor stage, performance status, and patient-reported outcomes.

Hamann et al say their findings suggest that certain clinician judgments “may have been influenced by preexisting ideas (eg, nihilism) about lung cancer patients and their treatment options.”

They write: “In essence, even if their lung cancer patients were sicker than their other solid tumor patients, clinicians perceived their [quality of life] to be lower and weight difficulties as more burdensome after controlling for how sick they were.”

They hypothesize that the association between smoking and lung cancer may affect clinicians’ views, and call for further exploration of this issue.

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