The speed at which advances in oncology are taking place, mainly thanks to immunotherapy, can be difficult to understand for patients, the non-specialist public, as well as non-oncology physicians who may find it difficult to keep up with the latest developments. drugs and their possible side effects. As revealed by the results of two studies that will be presented at the ESMO Congress 2021.
Immunotherapy is misunderstood by patients
To assess patients’ knowledge of immunotherapy, CareAcross, a multilingual platform that provides personalized education for cancer patients, conducted a survey among 5,589 of its members on the mechanism of action of their treatment, efficacy, side effects, and cost. “Immunotherapy has become an important therapeutic approach that is now administered every day to thousands of patients across Europe,” explained the study author, Paris Kosmidis, Co-Founder and Medical Director of CareAcross. “It is essential that these people are well informed because it is a complex treatment, which too often is mistaken for a miracle cure. The more they know about it, the better the communication with their medical team and, therefore, the better their results, ”he added.
When asked to select an explanation of cHow immunotherapy works from multiple possible responsess, nearly half of all survey participants diagnosed with breast, lung, prostate, or colorectal cancer responded with “I’m not sure / I don’t know”, while only one in three (32%) chose the correct answer “activates the immune system to kill cancer cells.”
Less than half of lung cancer patients gave the correct explanation of how immunotherapy works and overestimated its toxicity compared to other therapies
In the same way, more than half of those surveyed believe that immunotherapy starts working immediately, and only one in five correctly states that the treatment takes several weeks to be effective. “This is important because patients need to start their therapy with realistic expectations to avoid, for example, disappointment when their symptoms take a while to disappear,” Kosmidis stressed.
“Less than half of the lung cancer patients (41%) gave the correct explanation of how immunotherapy works, and although the subset of those who had actually received immunotherapy (241 patients) had up to twice the percentages of correct responses to our different questions, overestimated its toxicity compared to other therapies ”Kosmidis reported, emphasizing that the results observed in the survey reflect insufficient education.
Co-author Thanos Kosmidis, Co-Founder and CEO of CareAcross, was even more surprised to see widespread ignorance of the cost of immunotherapy, which can exceed 100,000 euros a year for a single patient: “In an ideal world, the cost of treatment would be irrelevant, but especially within the public health systems of Europe, people deserve to know the mechanisms that allow those who need it to access this type of therapy.”
According to the teacher Marco Donia, from Herlev-Gentofte Hospital and the University of Copenhagen, Denmark, an expert in immunotherapy who was not involved in the studies, it would be useful to improve general knowledge about a treatment that promises to be more tolerable and effective than chemotherapy , but that has a high cost in a context in which the incidence of cancer is increasing.
More than half of those surveyed believe that immunotherapy starts working immediately, and only one in five correctly states that the treatment takes several weeks to be effective
“However, it is not surprising that the subjects in this study who did not receive immunotherapy knew little about it, because as physicians we would not want to confuse our patients by talking to them about treatments that we will not offer them,” he said. “As a follow-up to this research, which is undoubtedly one of the first to investigate these questions, it would be interesting to conduct a survey focused only on patients who are direct candidates for immunotherapy or who are already being treated with it, and ask them not only what they know, but also how they would react to certain side effects. This is important because well-informed patients who know what to expect can do 90% of the work to prevent side effects from getting worse by treating them early. “
More training for non-cancer specialists
Better dissemination of knowledge about how cancer care has evolved can also be helpful for medical professionals away from oncology to improve the support that patients receive throughout their disease. In accordance with Conleth Murphy, from Bon Secours Hospital Cork, Ireland, co-author of a survey exploring physicians’ perceptions of the prognosis of cancer patients. “Receiving this news is a traumatic experience and patients often have urgent questions right away about what it means for their future,” Murphy said.
To assess physicians’ knowledge of current prognoses for different cancers, 301 non-oncologists and 46 medical oncologists and radiation therapists were asked to estimate five-year survival rates for 12 of the most common tumor types in all stages of the disease. They were also asked about six clinical scenarios with a defined cancer type, stage, and patient characteristics such as age. Their responses were then compared to the most recent survival figures from the National Cancer Registry of Ireland (NCRI).
Non-specialists significantly underestimated 5-year survival for all tumor types and were also more pessimistic than oncologists overall
“Non-oncologists, a diverse group of general practitioners and consultants from various hospital specialties, provided accurate estimates of survival at all stages for only two of the 12 cancersWhile the oncologists, who were specifically asked not to use their prognostic tools, gave the correct figures for four. In the more realistic task of predicting specific clinical scenarios, lNon-specialists significantly underestimated 5-year survival for all tumor types and were also more pessimistic than oncologists in general Murphy reported. “These results are in line with what we expected because most of the oncology knowledge of physicians can be traced back to the education they received during their formative years.
Confirming the frequency with which non-specialists come into contact with cancer patients, Cyril Bonin, a general practitioner in Usson-du-Poitou, France, explained: “I see around 10 new cases diagnosed each year in my practice, and around 50 of my 900 usual patients are cancer survivors who are currently in active treatment or are cured. Of his sickness. Taking into account that this figure is divided into different types of tumors, it is likely that our perception of a particular malignancy as family doctors is also influenced by the results of the specific cases that we have encountered “.
All physicians who routinely interact with cancer patients in their clinic MUST BE FAMILIARIZED with the latest statistics and trends in prognosis.
To avoid presenting people with unduly bleak expectations, Murphy recommended that all physicians who routinely interact with cancer patients in his clinic familiarize yourself with the latest statistics and trends in the forecast, while emphasizing that non-oncologists should always refrain from answering patients’ questions with numbers. . “In our survey, we found that one of the most underestimated 5-year survival rates among non-oncologists was that of stage IV breast cancer, which has evolved considerably over time and now reaches 40% in Ireland. These patients should avoid the traumatic effects of receiving a death sentence that no longer reflects current reality, ”he argued.
Commenting on the findings, Donia stated: “Oncology is a highly specialized field with many subgroups of different staging patients and so many prognoses, and a physician working on melanoma will not necessarily know the survival rates for different types and stages of cancer. breast ”. he said. “It is not surprising that physicians outside the field of oncology fare even worse, and it is not entirely realistic for us to expect professionals dealing with hundreds of different diseases to keep up with every facet of an oncology landscape. that changes quickly ”.
