Patients’ Hopes for Advanced Cancer Treatment

Context: Little is known about the hopes patients with advanced (incurable) cancer have for their treatment. Objectives: The objective of this study was to describe the treatment hopes of advanced cancer patients, factors associated with expressing specific hopes, and the persons with whom hopes are discussed. Methods: We surveyed 265 advanced cancer patients in the U.S. about their hopes for treatment at the baseline and after three months. We developed a taxonomy of hopes for treatment, which two investigators used to independently code patient responses. We explored associations between hopes for cure and patient covariates. Results: We developed eight categories of hopes. We were able to apply these codes reliably, and 95% of the patient's responses fit at least one hope category. The hope categories in order of descending baseline prevalence were as follows: quality of life, life extension, tumor stabilization, remission, milestone, unqualified cure, control not otherwise specified, and cure tempered by realism. Most patients reported discussing hopes with partners, family/friends, and oncologists; a minority reported discussing hopes with nurses, primary care physicians, clergy, or support groups. In logistic regression analysis, unqualified hopes for cure were more likely in younger patients and in those who did not endorse discussing their hopes with primary care physicians. Conclusion: Advanced cancer patients harbor a range of treatment hopes. These hopes often are not discussed with key members of the health care team. Younger age and lack of discussion of hopes with primary care physicians may lead to less realistic hopes for cure.