Survey reveals oncologistsí fears

Many oncologists worry about whether they are giving the best treatment to their patients, according to an international survey of 1,062 doctors and patients carried out on behalf of Anglo-Swedish pharmaceutical company AstraZeneca (AZ).

Doctors and patients from the UK, US, France, Germany and Italy were surveyed to evaluate the concept of trust between patient and doctor and the extent to which it factors into treatment decisions, compliance and intrinsic benefits. These included doctor job satisfaction, patient and doctor satisfaction with treatments and understanding the role of the relationship between the patient and the doctor in making treatment decisions, and how to establish what communication issues there are between doctors and patients.

A high number (69.4 per cent) of oncologists, haematologists, gynaecologists or breast cancer surgeons, worried about whether they were giving the best treatment to their patients.

The survey concluded that doctors needed support and help with difficult consultations.  Providing access to more efficacious treatments may lead to more positive outcomes for women with early breast cancer and, consequently, more positive conversations.

"What this survey shows is that, whilst the well-being of patients is always our first priority, there is a significant need to support the doctors themselves who regularly have to deliver bad, sad or difficult news, for example, about a breast cancer recurrence," stated Professor Lesley Fallowfield, co-author of the survey. 

"Recurrence is devastating for the patient, so doctors must have access to better treatments. This will in turn reduce the frequency of negative conversations," continued Fallowfield.

Fallowfield went on to suggest that doctors needed access to appropriate treatment choices, supported by greater clinical trial data and personal experience, as well as provision of better and earlier training on the importance of good communication and stronger support networks.

Examples
Arimidex (anastrozole) was stated as a good example of greater clinical trial data leading to better patient outcomes and more positive conversations between doctors and their patients.

Data from the Arimidex (anastrozole), tamoxifen, alone or in combination (ATAC) trial, which had a median of 68 months of follow-up, demonstrate that women treated with Arimidex experienced 26 per cent fewer recurrences, compared with those treated with tamoxifen. 

This data has led to Arimidex replacing tamoxifen as the Gold Standard treatment in a number of countries for post-menopausal hormone receptor-positive early breast cancer.  As a consequence, not only are patients more likely to remain recurrence free, but those doctors who stated that the worst part of their job was informing women of a recurrence were likely to have more positive conversations with their patients.

Key findings

Patient involvement in treatment decisions:

• 49 per cent of doctors believe that patients have sufficient information to be involved in treatment decisions and, for 86.6 per cent of patients, their doctor is their primary source of information
• 40 per cent of doctors reported involving patients in the treatment decision process, although an average of 79 per cent of patients reported being involved in treatment decisions
• 51.4 per cent of patients stated that they were more likely to stay on their treatment if they understood how and why it worked
• 92.4 per cent of doctors cited clinical trial data as crucial in building trust in treatment decisions, while nearly 80 per cent believed that relationships with patients become more challenging, if this data is not available

The nature of relationships between doctors and patients:

• 90 per cent of doctors believed that patients trust them to give them the best treatment, a point acknowledged by 84.8 per cent of patients who confirmed they did trust their doctorís treatment decisions
• 80.3 per cent of patients state that this trust and confidence is a vital component of their care, while 71.5 per cent consider their doctor to be the key person to help them find the support and guidance they needed to deal with their cancer

The personal and psychological impact of treating breast cancer:

• 41.8 per cent of doctors felt that conversations with their patients about a distant recurrence of their cancer was the worst aspect of their job and 41.6 per cent considered it to be the most stressful
• 62 per cent of doctors felt that telling a patient she remains distant recurrence free was the best part of their job
• A number of doctors also took worries about their patients who have recurred home with them (33.6 per cent) or worried about giving patients the best treatment (69.4 per cent)

What doctors want in order to help achieve more positive conversations?

• 72.4 per cent of doctors report that treatments that minimise recurrence meant that they have more positive conversations with patients and 68.4 per cent thought this made their job less stressful