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Internal Medicine Residents’ Perception of Cancer Prognosis

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Abstract

Cancer is the second leading cause of death in the USA. Many internal medicine physicians feel uncomfortable having to prognosticate; however, oncology patients often ask this of them. The inability to provide an accurate prognosis could lead a patient to make a treatment decision incongruent with their true wishes. We conducted this study to assess resident and attending physicians’ knowledge of cancer prognosis and to establish the source of residents’ knowledge. We conducted a prospective, cross-sectional study to assess internal medicine resident and attending physician knowledge of median survival for seven different oncologic case scenarios. Correct answers were defined by results of randomized, phase III trials. Residents were asked to identify the source(s) of information that most significantly influenced their choices. All residents and attending physicians affiliated with the University of Hawaii were invited to participate. A total of 67 of 85 surveys (78.8%) were completed, representing 41 residents and 26 attending physicians. Overall, the respondents correctly estimated median survival 42.6% of the time. The respondents underestimated more often than overestimated median survival (46.3% vs. 14.9%, p = 0.0001). Seventy-three percent of residents cited inpatient experience as influencing their oncologic knowledge. Internal medicine residents and attending physicians correctly estimate median survival of cancer patients less than 50% of the time and often underestimate survival. Inpatient rotations, where residents care for the oncologic patients experiencing significant complications of their cancer and treatment, may be giving them an unbalanced perspective on cancer prognosis.

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References

  1. Leading causes of death. Centers for Disease Control and Prevention https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Published March 17, 2017. Accessed April 19, 2017

  2. Weir H, Thompson T, Soman A, Møller B, Leadbetter S (2015) The past, present, and future of cancer incidence in the United States: 1975 through 2020. Cancer 121(11):1827–1837

    Article  PubMed  Google Scholar 

  3. Christakis N, Iwashyna T (1998) Attitude and self-reported practice regarding prognostication in a national sample of internists. Arch Intern Med 158(21):2389–2395

    Article  CAS  PubMed  Google Scholar 

  4. Glare P (2003) A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ 327(7408):195–190

    Article  PubMed  PubMed Central  Google Scholar 

  5. Clement-Duchene C, Carnin C, Guillemin F, Martinet Y (2010) How accurate are physicians in the prediction of patient survival in advanced lung cancer? Oncologist 15(7):782–789

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cheon S, Agarwal A, Popovic M, Milakovic M, Lam M, Fu W, DiGiovanni J, Lam H, Lechner B, Pulenzas N, Chow R, Chow E (2016) The accuracy of clinicians’ predictions of survival in advanced cancer: a review. Ann Palliat Med 5(1):22–29

    PubMed  Google Scholar 

  7. Goldvaser H, Milman Y, Dujovni T, Stern A, Mahamid M, Hanovich E, Zivony A, Shochat T, Yerushalmi R, Gafter-Gvili A, Brenner B, Shepshelovich D (2016) Perception of prognosis of cancer patients by non-oncologists. Int J Clin Pract 70(12):1027–1032

    Article  PubMed  Google Scholar 

  8. Lam PT (2008) Accuracy of clinical prediction of survival in a palliative care unit. Prog Palliat Care 16(3):113–117

    Article  Google Scholar 

  9. Kondziolka D, Parry P, Lunsford L et al (2014) The accuracy of predicting survival in individual patients with cancer. J Neurosurg 120(1):24–30

    Article  PubMed  Google Scholar 

  10. Heinemann V et al (2014) FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol 15(10):1065–1075

    Article  CAS  PubMed  Google Scholar 

  11. Scheithauer W, Rosen H, Kornek GV, Sebesta C, Depisch D (1993) Randomised comparison of combination chemotherapy plus supportive care with supportive care alone in patients with metastatic colorectal cancer. BMJ 306(6880):752–755

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Zhou C, Wu YL, Chen G, Feng J, Liu XQ, Wang C, Zhang S, Wang J, Zhou S, Ren S, Lu S, Zhang L, Hu C, Hu C, Luo Y, Chen L, Ye M, Huang J, Zhi X, Zhang Y, Xiu Q, Ma J, Zhang L, You C (2015) Final overall survival results from a randomised, phase III study of erlotinib versus chemotherapy as first-line treatment of EGFR mutation-positive advanced non-small-cell lung cancer (OPTIMAL, CTONG-0802). Ann Oncol 26(9):1877–1883

    Article  CAS  PubMed  Google Scholar 

  13. Yang JC-H, Wu Y-L, Schuler M, Sebastian M, Popat S, Yamamoto N, Zhou C, Hu C-P, O’Byrne K, Feng J, Lu S, Huang Y, Geater SL, Lee KY, Tsai C-M, Gorbunova V, Hirsh V, Bennouna J, Orlov S, Mok T, Boyer M, Su W-C, Lee KH, Kato T, Massey D, Shahidi M, Zazulina V, Sequist LV (2015) Afatinib versus cisplatin-based chemotherapy for EGFR mutation-positive lung adenocarcinoma (LUX-lung 3 and LUX-lung 6): analysis of overall survival data from two randomised, phase 3 trials. Lancet Oncol 16(2):141–151

    Article  CAS  PubMed  Google Scholar 

  14. Sandler A et al (2006) Paclitaxel–carboplatin alone or with bevacizumab for non–small-cell lung cancer. N Engl J Med 355(24):2542–2550

    Article  CAS  PubMed  Google Scholar 

  15. Scagliotti GV et al (2008) Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non–small-cell lung cancer. J Clin Oncol 26(21):3543–3551

    Article  CAS  PubMed  Google Scholar 

  16. Oettle H et al (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. JAMA 297(3):267–277

    Article  CAS  PubMed  Google Scholar 

  17. von Minckwitz G et al (2010) Impact of treatment characteristics on response of different breast cancer phenotypes: pooled analysis of the German neo-adjuvant chemotherapy trials. Breast Cancer Res Treat 125(1):145–156

    Article  Google Scholar 

  18. Bergh J et al (2012) FACT: an open-label randomized phase III study of fulvestrant and anastrozole in combination compared with anastrozole alone as first-line therapy for patients with receptor-positive postmenopausal breast cancer. J Clin Oncol 30(16):1919–1925

    Article  CAS  PubMed  Google Scholar 

  19. Crook JM, O’Callaghan CJ, Ding K, et al: A phase III randomized trial of intermittent versus continuous androgen suppression for PSA progression after radical therapy (NCIC CTG PR.7/SWOG JPR.7/CTSU JPR.7/UK Intercontinental Trial CRUKE/01/013). 2011 ASCO Annual Meeting. Abstract 4514. Presented June 6, 2011

  20. Venook AP, Niedzwiecki D, Lenz HJ, et al: CALGB/SWOG 80405: Phase III trial of irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab (BV) or cetuximab (CET) for patients (pts) with KRAS wild-type (wt) untreated metastatic adenocarcinoma of the colon or rectum (MCRC). 2014 ASCO Annual Meeting. Abstract LBA3. Presented June 1, 2014

  21. American Society of Clinical Oncology (2015) The State of Cancer Care in America, 2015: a report by the American Society of Clinical Oncology. J Oncol Pract 11(2):79–113

    Article  Google Scholar 

  22. Chen H et al (2007) What did you think of the hematology/oncology rotation? A survey of internal medicine residents. J Cancer Educ 2(1):50–55

    Article  Google Scholar 

  23. McFarland DC et al (2015) Inpatient hematology-oncology rotation is associated with a decreased interest in pursuing an oncology career among internal medicine residents. J Oncol Pract 11(4):289–295

    Article  PubMed  Google Scholar 

  24. McFarland DC et al (2017) Acute empathy decline among resident physician trainees on a hematology-oncology ward: an exploratory analysis of house staff empathy, distress, and patient death exposure. Psycho-oncology 26:698–703

    Article  PubMed  Google Scholar 

  25. Weinberger SE (2006) Redesigning training for internal medicine. Ann Intern Med 144(12):910–915 Web

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Kaiser Permanente Hawaii, Honolulu, HI, USA

    Loni Belyea

  2. Internal Medicine Department, University of Hawaii, Honolulu, HI, USA

    Jared D. Acoba

  3. University of Hawaii Cancer Center, Honolulu, HI, USA

    Jared D. Acoba

Authors
  1. Loni Belyea
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  2. Jared D. Acoba
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Corresponding author

Correspondence to Jared D. Acoba.

Ethics declarations

This study was conducted in compliance with the protocol approved by the Research and Institutional Review Committee and according to Good Clinical Practice standards, applicable federal regulations, and the Queen’s Medical Center research institutional policies and procedures.

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Appendix. Survey questions

Appendix. Survey questions

For the following patients, select the letter that corresponds with the median survival for patients with their type of cancer. Assume excellent performance status and an age of 60 years.

  1. 1.

    Stage IV colon cancer with unresectable liver and lung metastases treated with chemotherapy:

    1. a.

      ≤6 months

    2. b.

      10-12 months

    3. c.

      24-36 months

    4. d.

      48-60 months

  2. 2.

    Stage IV colon cancer with unresectable liver and lung metastases, patient declines chemotherapy:

    1. a.

      ≤6 months

    2. b.

      10-12 months

    3. c.

      24-36 months

    4. d.

      48-60 months

  3. 3.

    Stage IV lung adenocarcinoma with an EGFR mutation, no brain metastases:

    1. a.

      ≤6 months

    2. b.

      10-12 months

    3. c.

      24-36 months

    4. d.

      48-60 months

  4. 4.

    Stage IV lung adenocarcinoma without an EGFR mutation, no brain metastases:

    1. a.

      ≤6 months

    2. b.

      10-12 months

    3. c.

      24-36 months

    4. d.

      48-60 months

  5. 5.

    Stage II pancreatic cancer treated with pancreaticoduodenectomy and adjuvant chemotherapy:

    1. a.

      ≤6 months

    2. b.

      10-12 months

    3. c.

      24-36 months

    4. d.

      48-60 months

  6. 6.

    Stage IV prostate cancer with asymptomatic bone metastases to the lumbar spine and ribs:

    1. a.

      ≤6 months

    2. b.

      10-12 months

    3. c.

      24-36 months

    4. d.

      48-60 months

  7. 7.

    Stage IV breast cancer, bone is the only metastatic site, estrogen receptor positive, HER2 negative:

    1. a.

      ≤6 months

    2. b.

      10-12 months

    3. c.

      24-36 months

    4. d.

      48-60 months

Applies to residents only:

  1. 8.

    What are your sources of cancer knowledge that you used to answer the questions above? Check all that apply.

    1. a.

      knowledge obtained during interactions with inpatient physicians

    2. b.

      knowledge obtained during interactions with outpatient physicians

    3. c.

      knowledge obtained during interactions with oncologists

    4. d.

      knowledge obtained while on an oncology rotation

    5. e.

      personal readings

    6. f.

      medical school experience

    7. g.

      personal experience with patients

    8. h.

      a colleague’s experience with patients

    9. i.

      personal experience with family/friends

    10. j.

      Other: ___________________

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Belyea, L., Acoba, J.D. Internal Medicine Residents’ Perception of Cancer Prognosis. J Canc Educ 35, 983–987 (2020). https://doi.org/10.1007/s13187-019-01552-z

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  • DOI: https://doi.org/10.1007/s13187-019-01552-z

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