Is metastatic cancer curable? A survey of medical oncologists.

Abstract

12112 Background: More patients with metastatic cancer are living longer due to treatment advances like immune checkpoint inhibitors and targeted therapies. We aimed to determine oncologists’ attitudes about the possibility of cure in metastatic cancer and to understand how they discuss cure with their patients. Methods: We invited medical oncologists and medical oncology trainees via a national mailing list and social media to complete a digital 21-question purpose-built survey. Descriptive statistical analyses were conducted. Results: Between September and October 2024, 127 respondents completed the survey. Median age was 39 years (IQR 36-45). Most participants worked in an Australian (64%) metropolitan (88%) public practice (56%), and 51% were women. Clinical experience ranged from <5 years (36%), 5 to 10 years (24%) and >10 years (34%) since oncology qualification; 6% were trainees. The most frequently treated cancer types were breast (55% of participants), lung (52%), and colorectal (50%). 82% reported thinking patients with metastatic cancer can be cured. The types of metastatic cancer that participants thought had the highest chance of cure were testicular (81%), melanoma (32%) and colorectal (16%) (Table). At the time of diagnosis, 51% of participants reported they would tell a patient with metastatic cancer that cure is possible. After delivering treatment for metastatic cancer, 29% reported telling some patients that they have been cured, while 74% reported telling some patients that they may have been cured. During treatment, 1%, 4% and 17% of participants thought a patient had been cured if the cancer had not progressed 1, 2, and 5 years after starting treatment. A greater proportion thought cure was a realistic possibility when discussing the benefits of immunotherapy (83%) compared to chemotherapy (40%), but only 44% and 27% respectively reported they would tell patients this. When discussing prognosis, most reported using multiple ranges of time with probabilities e.g. best-case, typical-case and worst-case scenarios (68%). Conclusions: Although most oncologists in this survey believed metastatic cancer is curable, only a minority would tell a patient with metastatic cancer they have been cured. Median cure rates by disease as reported by participants. Cancer type Median cure rate (%) IQR (%) Testicular 81 71-88 Melanoma 32 20-50 Colorectal 16 9-25 Lung 13 6-21 Genitourinary 8 1-17 Breast 7 4-14 Gynaecological 6 1-12 Head and Neck 5 0-11 Gastroesophageal 2 0-7 Mesothelioma 2 0-7