Optimizing cancer cure dialog: an analysis of pancreatic cancer patients’ views regarding survival and cure

Abstract

Background Pancreatic ductal adenocarcinoma (PDA) is a highly lethal cancer. Clinicians commonly refer to surgical therapy as resection with curative intent. However, PDA cure rates after resection remain unknown and the definition of cure remains vague. We investigated how patients (the majority undergoing resection), family members, and clinicians understand the concept of cure, to better inform discussions with patients regarding PDA prognosis. Methods In a prospective survey, cohorts were asked to indicate the best definition of cure from three choices: 5-year survival endpoint (typically used in the literature), a biological endpoint without biochemical or radiographic signs of disease (similar to the NCI definition), or a practical endpoint where life span approximates similarly aged patients without PDA. Fleiss’ kappa statistic was calculated to measure inter-rater agreement. Results Patients, family members, and health care professionals ( N \u2009=\u2009200) agreed that renormalization of life expectancy was the preferred definition of cure in the context of pancreatic cancer. Inter-rater agreement was highest for the patient and family member groups (Fleiss’ kappa 0.27 and 0.40, respectively, P \u2009<\u20090.001), while variability was observed between health care professionals (Fleiss’ kappa 0.11, P \u2009<\u20090.001). Conclusions In all groups surveyed, the probability for a normal life expectancy is the preferred long-term metric in patients with early-staged pancreatic cancer. Renormalization of life expectancy appears to be an important therapy goal for PDA patients and it is advisable to address this topic during clinical discussions.