Elsevier

The Lancet Oncology

Volume 7, Issue 8, August 2006, Pages 668-675
The Lancet Oncology

Review
People's perceptions of cancer survivability: implications for oncologists

https://doi.org/10.1016/S1470-2045(06)70794-XGet rights and content

Summary

Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of people's perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of people's underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.

Section snippets

Sources of information

For members of the general public, the mass media remains the most frequently cited source of information about health matters, along with family, friends, family doctor, and, more recently, the internet.17, 18, 19 Health professionals, including oncologists, also pay attention to the mass media, to anticipate and respond to patients' enquiries about these matters.20 This attention is warranted, since medical journals and companies with products to sell provide a steady stream of press releases

Dissemination of information

A brief perusal of the websites and publications of cancer organisations shows wide variation in their treatment of survival. The US National Cancer Institute's What you need to know about cancer30 seems to studiously avoid any reference to survival, and published work specific to every cancer does the same. For example, the publication What you need to know about lung cancer31 includes a section entitled Questions for your doctor, but none of these questions refers to survival or even to

Are people interested in cancer survival?

Documented reports of patients' interest in survival show diverse findings. In a sample of women recently diagnosed with breast cancer,41 “almost all women wanted to know the probability of cure, the chances of the recommended treatment working and ten year survival figures with or without adjuvant therapy”. However, in another survey42 of patients, 80% wanted to know whether they would die from the cancer (a qualitative prognosis) whereas only about 50% wanted to know how long they would

Public perceptions of cancer survival

Cancer seems to be the illness of greatest fear within developed countries,45, 46 with immediate connotations of the word cancer being death and the unpleasant, painful nature of that death.47 Hence, although a positive reporting bias in the mass media suggests that people overestimate survivability, the visceral fear of cancer suggests that people's perceptions about survival are pessimistic.

As noted previously,48 only a few studies have been published that measure people's perceptions of

Qualifiers and caveats

Several issues mitigate unqualified acceptance of the various findings on people's perceptions of cancer survival. We comment on three of these: data reporting, question format, and optimism bias.

Implications

In view of the above caveats, two findings nevertheless seem reliable: people overestimate lung cancer survival and underestimate melanoma survival. Since longstanding tobacco-quit campaigns use lung cancer to stimulate quitting, the overestimation of lung cancer survivability seems surprising. Familiarity might lessen a threat's effect, as similarly stated by Seneca: “Constant exposure to dangers will breed contempt for them” (De Providentia IV; psychologists now call this process

Search strategy and selection criteria

We searched Google and Google Scholar for “beliefs about cancer survival”, “beliefs about probability of cancer survival”, “knowledge of cancer”, and “knowledge of cancer survival”. Reports seeming to be of relevance were then searched through PubMed, MEDLINE, or PsychInfo. We also searched cancer organisation websites published in English. Google Scholar generated many papers, particularly about “beliefs about probability of cancer survival” (n=5230). A review of the titles or abstracts

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