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Life and treatment goals of patients with advanced, incurable cancer

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Abstract

Purpose

Goals of care conversations have been suggested as a strategy for helping patients with advanced cancer manage the uncertainty and distress associated with end-of-life care. However, knowledge deficits about patient goals limit the utility of such conversations. We described the life and treatment goals of patients with incurable cancers, including goal values and expectancies. We examined the associations between paramount goals and patient prognosis, performance status, and psychological adjustment.

Methods

Patients with advanced lung cancer, gastrointestinal cancer, or melanoma (N = 84) completed measures of prognosis for 12-month survival, hope, optimism, depression, and anxiety. Oncologists provided patient performance status and prognosis for 12-month survival. We conducted interviews with a subset of patients (N = 63), eliciting life and treatment goals, values, and expectancies.

Results

Patient life goals resembled goals among healthy populations; whereas, treatment goals were perceived as separate and more important. Cure and fight cancer emerged as the most important goals. Patients who valued cure the most had worse performance status (M = 1.46 vs. 0.78) and more depressive symptoms (M = 6.30 vs. 3.50). Patients who valued fight cancer the most had worse self-prognosis (M = 69.23 % vs. 86.11 %), fewer treatment goals (M = 2.08 vs. 3.16), and lower optimism (M = 15.00 vs. 18.32).

Conclusions

Patients with advanced cancer perceive treatment goals as separate from and more important than life goals. They hold optimistic expectancies for achieving their goals and for survival. Valuing cure highly may put patients at risk for experiencing psychological maladjustment.

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Notes

  1. Although we could hypothesize that some goals were implicitly related to the patient’s cancer (e.g., “To live another 20 years”), we chose to only categorize goals that explicitly mentioned cancer or its treatment in order to minimize the influence of the investigator’s subjective judgment.

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Acknowledgments

This research was supported by a research scholar grant (RSGPB-10-014-01-CPPB) from the American Cancer Society awarded to the first author.

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Authors and Affiliations

  1. Department of Psychology, Indiana University-Purdue University, 402 North Blackford St., LD 124, Indianapolis, IN, 46202, USA

    Kevin L. Rand, Daniella A. Banno & Amanda M. Shea

  2. School of Medicine, Indiana University, Indianapolis, IN, USA

    Larry D. Cripe

  3. Indiana University Simon Cancer Center, Indianapolis, IN, USA

    Kevin L. Rand & Larry D. Cripe

  4. Walther Program in Palliative Care Research, Indianapolis, IN, USA

    Kevin L. Rand & Larry D. Cripe

  5. Research in Palliative and End-of-Life Communication and Training Center, Indianapolis, IN, USA

    Kevin L. Rand & Larry D. Cripe

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  1. Kevin L. Rand
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  2. Daniella A. Banno
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  4. Larry D. Cripe
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Correspondence to Kevin L. Rand.

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Rand, K.L., Banno, D.A., Shea, A.M. et al. Life and treatment goals of patients with advanced, incurable cancer. Support Care Cancer 24, 2953–2962 (2016). https://doi.org/10.1007/s00520-016-3113-6

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  • DOI: https://doi.org/10.1007/s00520-016-3113-6

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