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Cancer. 2015 Jun 1;121(11):1891-7. doi: 10.1002/cncr.29250. Epub 2015 Feb 11.

Patient beliefs that chemotherapy may be curative and care received at the end of life among patients with metastatic lung and colorectal cancer.

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Division of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts.
Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California.
Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California.
Johns Hopkins Kimmel Cancer Center, Baltimore, Maryland.
Los Angeles Fielding School of Public Health, University of California, Los Angeles, California.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Health Science, California State University, Fullerton, California.



Many patients with incurable cancer inaccurately believe that chemotherapy may cure them. Little is known about how such beliefs affect choices for care at the end of life. This study assessed whether patients with advanced cancer who believed that chemotherapy might offer a cure were more likely to receive chemotherapy in the last month of life and less likely to enroll in hospice care before death.


This study examined patients diagnosed with stage IV lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance consortium, a population- and health system-based prospective cohort study. Among 722 patients who completed a baseline survey and died during the study period, logistic regression was used to assess the association of understanding goals of chemotherapy with chemotherapy use in the last month of life and hospice enrollment before death; adjustments were made for patient and tumor characteristics.


One-third of the patients (33%) recognized that chemotherapy was "not at all" likely to cure their cancer. After adjustments, such patients were no less likely than other patients to receive end-of-life chemotherapy (odds ratio [OR], 1.32; 95% confidence interval [CI], 0.84-2.09), but they were more likely than other patients to enroll in hospice (OR, 1.97; 95% CI, 1.37-2.82).


An understanding of the purpose of chemotherapy for incurable cancer is a critical aspect of informed consent. Still, advanced cancer patients who were well informed about chemotherapy's goals received late-life chemotherapy at rates similar to those for other patients. An understanding of the incurable nature of cancer, however, is associated with increased hospice enrollment before death, and this suggests important care outcomes beyond chemotherapy use.


chemotherapy; communication; end of life; informed consent; palliative

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