Cancer Patients More
Optimistic than Doctors

(HealthScout) -- Blood cancer patients are more optimistic about their odds of being cured by aggressive therapy even when their physicians feel the outlook is bleak, researchers say.

A study of stem cell transplant recipients shows that doctors and leukemia patients generally agree on the prospect of a favorable outcome when the disease is less advanced. But a rift appears when the illness, and therefore the likelihood of survival, is worse, and patients become much more optimistic then their caregivers.

Dr. Stephanie Lee, a Harvard University oncologist and lead author of the study, says the researchers weren't surprised to find that doctors and patients had different levels of optimism. "But the magnitude of the discrepancy in the high risk group" was impressive, she says.

Lee and her colleagues surveyed 263 adult patients with various forms of leukemia who had chosen to undergo stem cell transplants, a procedure to reprogram the blood stream with cancer-free cells. The therapy can lead to cure, but it is often deadly.

Before the treatment, patients and doctors were asked to rate their chances of being cured, both with and without a stem cell graft, as well as the recipients' prospects for surviving the transplant itself.

Doctors and patients were largely in agreement, and on target, in estimating the odds of making it through the transplant in cases where the risk of death was less than 30 percent. But for patients with worse outlooks, such as those with advanced leukemia receiving cell grafts from another person, their physicians' forecast of success dimmed -- yet theirs remained optimistic.

Why the rosier outlook?

In all, nearly 80 percent of patients painted a rosier picture of their chances of being cured than did their doctors. "A lot of these patients were telling us that they expected a high mortality and relapse [of cancer], and yet they were willing to go ahead" with the procedure, Lee says.

Dr. Jane Weeks, a Dana-Farber doctor and a co-author of the paper, says it's important to try to understand not only whether patients have different expectations about their odds, but why. Although many people don't want to believe they're dying, "it may be just as hard for the doctors to present really grim statistics as it is for patients to hear them."

Dr. Nicholas Christakis, a University of Chicago researcher who studies risk perception, says a cheerful outlook is important but not always desirable.

"I'm not opposed to optimism. It's just that optimism can sometimes be harmful," says Christakis, author of Death Foretold: Prophecy and Prognosis in Medical Care (University of Chicago Press, 2000).

"If the patients think the treatment may be more beneficial than it is, they may make choices counter to their interests," he says. At the same time, that care -- say, stem cell transplants -- carries a high cost for society.

Christakis says he's not in favor of "terminal candor" or "truth dumping," giving patients the bluntest of forecasts. Rather, he says, he supports offering people the most accurate information possible and then letting them decide their course of care. In some cases, he says, "we need to shift our optimism away from a cure of the disease and toward a notion of good care" at the end of a life.

Dr. Howard Bauchner, a Boston University pediatrician, says it's not surprising that very sick people would be more hopeful their physicians. "Most people, when they're facing critical decisions, want to be optimistic," says Bauchner, who has studied how doctors and patients make treatment decisions, says. So they may ignore the odds and probabilities.

But what's more complex, Bauchner says, is making sure that patients are fully informed of their condition and chances of surviving. Hospitals have consent forms that patients sign to formally acknowledge they've been apprised of risk. Yet whether they truly understand those risks isn't clear, he says.

To read an article about how pessimism can shorten the lives of cancer patients, check out the American Psychological Association.

To learn more about stem-cell transplants, try the Cure for Lymphoma Foundation. For more on leukemia, visit the Leukemia & Lymphoma Society of America.

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