Most patients getting chemotherapy for incurable lung or colon cancers mistakenly believe that the treatment can cure them rather than just buy them some more time or ease their symptoms, a major study suggests. Researchers say doctors either are not being honest enough with patients or people are in denial that they have a terminal disease. The study highlights the problem of overtreatment at the end of life — futile care that simply prolongs dying. It's one reason that one quarter of all federal Medicare spending occurs in the last year of life. For cancers that have spread beyond the lung or colon, chemo can add weeks or months and may ease a patient's symptoms, but usually is not a cure. This doesn't mean that patients shouldn't have it, only that they should understand what it can and cannot do, cancer experts say. Often, they do not. Dr. Jane C. Weeks at Dana-Farber Cancer Institute and researchers at several other Boston-area universities and hospitals led a study of nearly 1,200 such patients around the U.S. All had been diagnosed four months earlier with widely spread cancers and had received chemo. Surveys revealed that 69 percent of those with lung cancer and 81 percent of those with colorectal cancer felt their treatment was likely to cure them. Education level and the patient's role in care decisions made no difference in the likelihood of mistaken beliefs about chemo's potential. Hispanics and blacks were three times more likely than whites to hold inaccurate beliefs. Federal grants paid for most of the research. In an editorial that appears with the study in Thursday's New England Journal of Medicine, two doctors question whether patients are being told clearly when their disease is incurable. Patients also may have a different understanding of "cure" than completely ridding them of a disease — they may think it's an end to pain or less disability, note Dr. Thomas J. Smith of Johns Hopkins University School of Medicine and Dr. Dan L. Longo, a deputy editor at the medical journal. "If patients actually have unrealistic expectations of a cure from a therapy that is administered with palliative intent, we have a serious problem of miscommunication," they write. "We have the tools to help patients make these difficult decisions. We just need the gumption and incentives to use them." incl?ga ??'?e.

 

  Most had surgery for their cancer, and many also had chemotherapy. They gave tumor tissue samples that could be tested for gene activity. Researchers focused on one gene, PIK3CA, that is involved in a key pathway that fuels cancer's growth and spread. Aspirin seems to blunt that pathway, so the scientists looked at its use in relation to the gene. In those whose tumors had a mutation in that gene, regular aspirin use cut the risk of dying of colon cancer by 82 percent and of dying of any cause by 46 percent during the study period of about 13 years. Only two of the 62 regular aspirin users whose tumors had the mutated gene died within five years of their cancer diagnosis versus 23 of 90 non-aspirin users with such a mutation. The results are "quite exciting," said Dr. Boris Pasche, a cancer specialist at the University of Alabama at Birmingham who wrote an editorial that appears with the study in the medical journal. Half a dozen drugs are used to treat colon cancer, but only one meaningfully extends survival in people whose cancers have not widely spread, he said. "Now we may have aspirin. That's why it's a big deal," Pasche said. In the study, the dose of aspirin — baby or regular — didn't seem to matter, just whether any aspirin was regularly used. The test for the gene is not expensive and is simple enough that most cancer centers should be able to do it, Chan and Pasche said. The National Institutes of Health and several foundations paid for the study. One of the 17 authors consults for Bayer, a leading aspirin maker. Pasche has been a paid speaker for two companies that make cancer treatments and has two patent applications under review related to cancer treatment. Researchers warn that aspirin may not be responsible for the improved survival seen in this study. Differences in how the patients' cancer was treated could have played a role. For that reason, they say the next step should be a study where some people with the mutated gene are given aspirin and others are not, so their cancer outcomes can be compared more directly.