A diagnosis of a cancer sometimes changes the priorities and perspective of an individual. Previous literature suggests that cancer patients were more likely to indicate support for cancer treatment than non-cancer patients, even when the treatment may not be curative and when the odds for cure are low. We have carried out a questionnaire study to evaluate the attitude towards cancer treatment of a convenience sample of individuals attending a community cancer center situated along the “Bible belt” of the USA. A total of 460 individuals were recruited (100 newly diagnosed cancer patients; 100 cancer patients in complete remission; 60 cancer patients with relapsed/refractory disease; 100 non-cancer patients and 100 care-givers of cancer patients). The overall questionnaire return rate was 88% (range 84–91%). We used Chi square tests in two-way tables to test for significance.

When asked whether or not the subject will agree to treatment that might be associated with uncomfortable side-effects for a cancer with less than 10% cure rate, 63.1% of cancer patients responded positively when compared to 48.9% of non-cancer patients (p = 0.02). This difference is most notable when relapsed/refractory patients were compared to non-cancer patients (70.6% vs 4.9%) (odd ratio = 0.345) (p = 0.007). These results, therefore, indicate that the positive attitude of most cancer patients to high risk cancer treatment is observed even in a region heavily influenced by religion. Moreover, the preference for treatment is stronger when the patient is faced with a real issue, rather than a hypothetical choice. Therefore, patients should be given an opportunity to revise living wills and other documents after they have been diagnosed with cancer.

The study next examined the attitude towards intervention for potentially fatal treatment-related complications. Cancer patients were marginally more likely to agree (69.8%) to intervention of the life-threatening complications than non-cancer patients (60.0%) (p = 0.09) even if their life expectancy from the cancer is only 6 months. However, these differences were no longer apparent if the complication has arisen from a cancer that has a cure rate of 30%. Younger patients were also more likely to agree to intervention of life-threatening complications than older patients whether the intervention was for a cancer with a life-expectancy of only 6 months (p=.002) or 30% cure rates (p=.0002). Our study therefore suggests that most cancer patients, even those in the ‘Bible belt” and especially those with relapsed/refractory disease, expect oncologists to treat their disease and treatment-related complications whether or not the intervention only produces low cure rates or prolongs their life marginally. However, older patients are more likely to decline treatment.

We next compared the responses from cancer patient care-givers to cancer patients. There was no significant difference in the attitude towards treatment between cancer care-givers and cancer patients regardless of how the question was posed, suggesting that daily contact with cancer patients may have positively influenced the attitude of individuals to high risk cancer treatment. This result also suggests that, when the patients are seriously ill and unable to make decisions on treatment, the decision by the care-givers probably reflects that of the patients.

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