Let's Talk about Talking about Cancer

Let's Talk about Talking about Cancer

Clement Adebayo Adebamowo, MD, ScD

Sep 30, 2010

In this post, I would like to share the misunderstandings and anxieties that result when critical information is withheld from patients with cancer and from their family members.

Recently, a relative of a patient with breast cancer (a patient unknown to me) contacted me through e-mail, imploring me to “provide information” that the woman’s own doctors refused to communicate. From a frantic description that detailed surgery, chemotherapy, and a “wound that would not heal,” I could surmise that the situation was very serious. I asked for more information about her sister’s illness, the stage, the name, and any contact information for the woman’s doctors.

After a delay, I received another e-mail from the relative saying that the doctors “are not forthcoming.” However, the relative was able to tell me that her sister had stage 4 breast cancer and that the patient was now on oxygen and unable to walk. Despite the grim outlook, the relative was desperately trying to arrange travel to another country by ambulance for further treatment and surgery. In closing, the relative asked for my advice. Here is the essence of my response:
"Regrettably, the way medicine is practiced in some areas, some doctors are not willing to provide this kind of information. Nevertheless, you have provided enough information for me to give you honest but painful advice. Stage 4 breast cancer is an incurable and terminal disease. This is unfortunately the truth that we all have to face. There is no benefit that is likely to come from the trip when someone is already on oxygen. At this point, the doctors need to be forthcoming with you that her chances of survival are low. I know the human feeling of wanting to do the best for someone’s loved one, but sometimes the best thing is not to keep poking and treating ineffectually. I am sorry and hope that you will take the advice in the spirit with which it has been given."

The final e-mail I received conveyed a deep appreciation for my “forthrightness” along with the wish that the other doctors had been honest with them from the beginning. I was then told the woman’s sister had passed away—an inevitability that an expensive, painful, and anxiety-filled trip and subsequent surgery would not have changed.

Let us start a conversation on talking to our patients about cancer. Your comments are welcome.


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