What Does Curative Intent Mean? A Survey of Oncology Clinicians at a Comprehensive Cancer Center

Background: Cancer treatment intent sets expectations and influences treatment intensity for patients with cancer and oncology clinicians. It is not known what probability-of-cure threshold oncology clinicians use when considering a treatment to have a curative intent. The objective of this study was to determine the lowest probability of cure needed for solid tumor and hematologic oncology clinicians to consider cancer treatment curative in intent. Methods: This study was part of a cross-sectional survey of oncology clinicians (physicians and advanced practice providers [APPs]) at a comprehensive cancer center in the United States. Participants answered the question, “What is the lowest probability of cure for you to consider a cancer treatment to be of curative intent?” by providing a whole-number percentage between 0% and 100%. Results: The overall survey response rate was 66% (245 of 369 eligible clinicians), with 195 (80%) participants completing the curative intent question. Most responders were aged ≤49 years (n=137; 70.3%), female (n=124; 63.6%), and physicians (n=98; 50.3%). Solid tumor oncology clinicians reported a median probability of cure of 35% (IQR, 20%–75%), while hematologic oncology clinicians reported a median probability of 34% (IQR, 20%–70%) ( P =.90). Physicians across both specialties reported a lower probability of cure necessary for treatment to be considered curative in intent than APPs (median, 20% [IQR, 10%–40%] vs 50% [IQR, 30%–80%]; P <.001). Multivariable regression analysis showed that APPs (odds ratio, 2.88; P <.001) and clinicians of Asian race (odds ratio, 1.83; P =.01) were independently associated with a higher probability of cure required for treatment to be considered curative in intent. Conclusions: Our study revealed high variability in how clinicians dichotomize probability of cure into cancer treatment intent, with a significant discrepancy between APPs and physicians. This level of heterogeneity highlights the need to have consistent communication and appropriate expectation setting for patients, caregivers, and other health care professionals.