Were you shocked to know your cancer is not curable?
Many Terminal Cancer Patients Mistakenly Believe A Cure Is Possible
by David Schultz
Dr. Joel Policzer checks on his
patient, Lillian Landry, in the hospice wing of an Florida hospital in
2009. A new study found that many terminally ill cancer patients don't
fully understand their prognosis.
J. Pat Carter/AP
Doctors are often called upon to deliver bad news to
patients, and there isn't much that's worse than a diagnosis of an
advanced-stage cancer for which there is no cure.
there's new evidence that a surprisingly large majority of patients who
receive this news don't fully comprehend it, or perhaps willfully choose
to ignore it.
Almost three out of every four patients
diagnosed with stage IV lung or colon cancer believe that chemotherapy
can cure them of their disease, according to a survey of more than 1,100
cancer patients by the Dana-Farber Cancer Institute.
And yet for cancers diagnosed at that late of a stage, chemotherapy has
been definitively shown to extend lifespan by only a few months at
Deborah Schrag, a physician at Dana-Farber who
helped conduct the study, says patients who don't understand the
severity of their diagnosis can't make plans for their final few months
"If you think chemo is going to cure you," she
says, "maybe you don't have that conversation about a trip to
California. Maybe you spend your time getting chemo and you don't spend
time on your boat. We know that when people have unrealistic
expectations they're much less open to discussing end-of-life planning."
The survey, which appears this week in the New England Journal of Medicine,
also found that patients who rated their doctor as being a good
communicator were more likely to hold mistaken beliefs about their
prognosis. Schrag says this indicates that some doctors may be trying to
tell their patients what they think they want to hear, rather than the
"It's not that [doctors] don't disclose that chemotherapy
won't cure the cancer. It's that we disclose quickly and then move on,"
she says. "But patients always want positive news. In the short term,
people will be happier if you give them happier news."
needs to be continued communication about the prognosis and it needs to
be done early on," she says. "I don't think physicians do it
particularly well. ... Many physicians just have a very hard time
communicating that they're not going to be able to cure the patient."
Swain says the results of the Dana-Farber survey are a sign
that doctors need do a better job of helping terminally ill cancer
patients let go of false hopes without squashing all hope.
don't want to take away hope from patients," says Swain. "They're not
going to be cured but it's not like they're going to die instantly. So
it is a really hard balance to achieve."
And comprehensive palliative care still be hard to find: only 59 percent of hospitals with more than 50 beds offer it, as Michelle Andrews reported last year.