There is no mistaking that the notion of hope is pervasive at the Annual Meeting.

During Sunday's Plenary Session there was a nearly palpable energy in the room: Hope for what these findings might mean for our patients! Hope that these therapies may lead to better outcomes for our patients with these cancers!

There was a focus on another kind of hope on Sunday, brought to us by Drs. Donehower and Hoffman in the Clinical Problems in Oncology Session Doctor, Is There Any Hope?  Communicating Prognosis while Maintaining Hope at the End of Life. 

Discussions about poor prognosis are exquisitely difficult; a fact I believe we readily accept. The reasons these discussions are so difficult may vary among us, ranging from lack of experience in holding such conversations to transference to our struggle to accept treatment failure.

The session emphasized a concept that may be counter-intuitive to us: honest prognostic information preserves hope.

It is difficult for us to accept when our interventions either fail to cure patients of their cancer or may offer them little benefit.

By emphasizing the positive, hope is preserved:
-Reassurance about actively addressing symptoms
-Reassurance that the goal of hospice is not to hasten death but rather to provide intensive comfort measures. It has been shown that hospice may be associated with improved quantity of life in addition to quality of life.
-Reassurance that the adage there is nothing more we can do is absolutely not true (I say we rid our vocabulary of that phrase altogether!)
-Reassurance that we continue to be advocates for our patients and stakeholders in their well-being

Providing as accurate prognostic information as possible to our patients and their loved ones enables them to better establish goals of care and therapy.  It can lead to earlier access to palliative care services and avoidance of aggressive measures at the end of life that will cause suffering. Early discussions about prognosis and subsequent discussions when prognostic information may change empowers our patients and their loved ones to re-frame life goals as needed and may lessen the emotional impact of advanced cancer. 

As we move forward, let us think about the spectrum of hope for our patients and utilize all opportunities to encourage it. 


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