Oncologists often shelter patients with stage IV cancer from the realities of their diagnoses, according to a new article.
As reported in a recent “perspective” article by a researcher under the auspices of NYU Winthrop Hospital’s Research Institute, such practices deprive patients of “a full understanding of their poor prognosis, possibly compromising their ability to make informed choices.”
“We hope this article causes a strong reaction in the professional oncology community, and stirs much-needed debate on the topic,” says the author, Donald Brand, PhD, adjunct professor at NYU Long Island School of Medicine and former director of health outcomes research at NYU Winthrop Hospital.
Dr. Brand’s article, titled “The Stage IV Shuffle: Elusiveness of Straight Talk About Advanced Cancer,” recently published in the Journal of General Internal Medicine.
“I recommend straight talk about late-stage cancer that can give patients realistic hopes instead of false hopes that are apt to betray later on,” says Dr. Brand. “Oncologists may be well-meaning in their efforts to mitigate the shock of bad news, but glossing over the facts of efficacy may explain why so many patients believe their metastatic cancer can be cured and why so few patients with advanced cancer decline chemotherapy.”
Dr. Brand argues that the same frank communications are needed from health educators as they prepare materials about advanced cancer, and from researchers as they report study findings. The latter, says Dr. Brand, often focus on statistics that involve tumor response to treatments rather than relaying survival statistics.
Dr. Brand points out that, in recent years, more than half of clinical trials leading to approval of drugs by the U.S. Food and Drug Administration for oncologic indications relied on outcomes such as those related to the suppression of tumor growth—rather than on survival, which “tends to make results look more favorable.”
According to Dr. Brand’s article, pointing out to a patient that treatment is unlikely to help “does not take away all hope, as some defenders of the stage IV shuffle might argue. “Candid discussion can give the patient realistic hopes… While it is not the clinician’s job to challenge a patient who hopes to beat the odds, it is the clinician’s job to disclose the odds when a patient wants to know.”
“The Stage IV Shuffle: Elusiveness of Straight Talk About Advanced Cancer” currently appears online in the Journal of General Internal Medicine and will appear in print in an upcoming journal issue.