I’m always struck that some people diagnosed with cancer want to know absolutely everything about their disease while others just want to be told when to show up for treatment. Some people complain that their doctors give them too much information while others complain that their doctors give them too little.
Every doctor I’ve known will truthfully answer whatever questions are asked. The more difficult issue for doctors is what information to offer in the absence of questions. This is especially relevant when patients are first diagnosed. Many people experience a brain freeze when they hear the words, “You have cancer,” and are unable to ask any questions at all.
The basic information – diagnosis and suggested treatment – has to be shared, of course. But there’s SO much information that could be discussed related to a cancer diagnosis. For example, should patients be told the survival statistics for their type of cancer? Some patients diagnosed with a serious cancer want to know their chances of survival because it helps them plan their lives.
Others don’t want to know because they want only positive thinking around them. There’s no right or wrong in this. What is important is for the doctor and patient to have a shared understanding of what works best for the patient.
Some doctors, of course, are better at sensing the patient’s wishes than others. I encourage patients to tell their doctors how much or how little they want to know.
Another important time for clear communication is when a patient has metastatic or advanced cancer. Many of these patients can live for years with a good quality of life by receiving chemotherapy on an ongoing basis. At some point in time, though, cancer cells mutate and become resistant to the current treatment and another treatment has to be initiated. When there are no more treatments to offer, the focus turns to comfort care, often through hospice.
Some people want to try every treatment option in order to extend their lives as long as possible. Others would rather focus on quality of life and not go through another round of chemotherapy. What’s important is for the patient to control these decisions.
Ending active treatment is a very personal decision and depends on the patient’s condition and the treatment options at a specific point in time. But I encourage patients to share their general mindset with their oncologist. It’s OK to say, “If I only have a few months to live, I’d rather spend those months in hospice.” By saying that you’re comfortable with hospice, it may allow the doctor to introduce hospice as a reasonable option earlier than he or she would have otherwise.
It’s also OK to say, “My daughter is getting married next summer and I want to do everything possible to be at that wedding.”
Like so much in life, the more that we share our wishes, the more likely it is that we’ll get what we truly want.
Reprinted with the permission of the Ithaca Journal.
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