Cancer surgeons' attitudes and practices about discussing the chance of operative "cure"

While physician attitudes about treatment goals have been examined around end-of-life care, surgeon attitudes regarding communication of therapeutic goals prior to cancer-directed operations have not been investigated. We examined how surgeons discuss the potential for cancer "cure" prior to operative treatment and how surgeons perceive patient priorities and treatment goals.

Surgeons were invited to complete a Web-based survey about attitudes and practices when discussing cancer-directed operations, including how they defined cancer cure and whether and how they discussed cure as a treatment goal.

A total of 551 e-mail invitations were sent and opened; 205 responses were received (response rate 37.2%). While 44.9% of surgeons reported being asked about cure in all or most discussions, only 37.6% used the word cure as often. When discussing cure, an equal number of surgeons reported using qualitative versus quantitative language to express probability of cure (45.7% and 47.4%, respectively). Roughly one third of surgeons (n = 65, 31.7%) defined cure as 5-year, disease-free survival; 36.1% (n = 74) defined cure as absence of recurrence over the patient's lifetime; and 21 (10.2%) defined cure as return to baseline population risk for that specific cancer. Over half of surgeons (n = 112, 56.9%) perceived that to "be cured" was among the top 2 priorities of patients presenting for operative treatment.

When discussing relative benefits and goals of therapy, surgeon self-reported discussions of cure varied considerably. Despite identifying cure as a top priority for patients, surgeons were not inclined to incorporate cure into discussions of risks, benefits, and goals of therapy.