Patient

Do Oncology Doctors give cancer patients a false sense of hope even though they know that there is no hope for them.

It so happens that this question keep propping up in medical settings. I have had my own share of these ethical questions… Quora’s Dr Gary Larson was quite up-beat about this question and penned down this elaborate response… Enjoy!!!

I remember from my first class in patient communication as a first year medical student that The message is in the receiver. A physician can do everything possible to accurately communicate the prognosis to a cancer patient, but if they (either the patient or both the patient and their family members) are not ready to hear it, then there’s no way they will. Not that they won’t come back later and accuse me of “lying to them” or giving them “false hope”. Situations involving this level of denial are rare, but happen once in a great while.

A more common scenario is this one. I am seeing a patient for the first time with stage III non-small cell lung cancer:

Patient: “So how much time do I have?”

Me: “I can’t tell how long you will live, because survival rates fall along a bell curve – some people with your disease may die in a month and some will be cured and live out the rest of their normal life span. All I could give you are statistics based on large groups of patients with your disease.”

Patient: “That’s OK, I understand – what are the statistics?”

Me: “If you take a hundred patients with your stage of non-small cell lung cancer, eighty percent of them will live between six months and a year – but remember, you have a lot of good characteristics prognostically.

  • You haven’t lost a significant amount of weight.
  • You have a good performance status – you are able to perform essentially all of your normal activities.
  • (Weight loss and performance status are the two most important prognostic factors)
  • You are young and otherwise in good health – you are a non-smoker.
  • Despite the fact that your cancer has spread to your mediastinal lymph nodes, the tumor is relatively small, as are the lymph nodes.

so – you may be one of the ten percent of people with stage III non-small cell lung cancer who are actually cured.”

Hopefully, at this point the patient will have enough cautious optimism to approach treatment with some enthusiasm. I will be seeing him/her regularly while they are going through treatment and they will either do well or they won’t – but we will continue to develop a relationship as time goes on, and they will get used to actually hearing what I have to say, so if things change (for example, if they develop metastatic disease) they are likely to hear me tell them about that – and the fact that they may now be in that “six month” group.

If a similar patient without those good prognostic features asks about their chances, I’m likely to stop after saying “…six months to a year” – in which case the patient leaves discouraged and sometimes angry, but still able to develop a relationship with me over time, so I can communicate the truth about their chances as time goes on.

Early in my career, I wasn’t nearly as good at telling patients their time was short or that further treatment was not likely to help, but I have grown emotionally through the years. In the eighties, the problem was probably more me than them, but now, the patients pose the challenge in communicating. As a result of the past few decades of practice, I am now able to communicate the truth to most patients in a way that they can absorb – at the time that they are most likely to hear it. Like every skill, it takes practice to learn – but unlike many skills, this one also requires the ability to tolerate emotional discomfort. When I share a truth with a patient that makes them feel fear or sadness, I have to feel it along with them.

 

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