According to cancer.org, there were approximately 1.68 million new cancer cases in the United States, while over 595,000 people died from some form of the disease in 2016. A 2016 report by the American Cancer Society suggests that there are 15.5 million cancer survivors in the United States; a figure set to grow by 2026. This is in line with the 13% fall in cancer deaths in the nation between 2004 and 2013.
Although the increasing survival rate is encouraging news, cancer patients in the U.S. receive an insufficient level of information regarding their treatment plan. They are often encouraged to try a new course of treatment without adequate information regarding the chances of success, the length of time they have to live, or even whether the condition is curable. As a result, patients and their families receive false hope and spend a fortune on medications and painful chemotherapy that may have little or no chance of working.
There is apparently a collective failure on behalf of patients and their doctors. While cancer patients have more treatment choices than ever, they have no idea which option is best for them or whether the option they choose is historically effective. Physicians are either unwilling or unable to provide answers, and cancer patients are often reluctant to ask the right questions. According to a study by the National Cancer Institute, around 38 percent of cancer patients didn’t even have a discussion about longevity with their oncologist.
Incredibly, a large number of cancer patients don’t know basic information such as projected life expectancy, the curability of the condition, or the reasons behind a course of chemotherapy or radiation treatment. Consequently, patients with advanced cases of cancer have no time to make plans on how they want to spend their last days.
A Difference of Opinion
The lack of communication extends to the difference between the opinions of patients regarding their wellbeing and outlook and the opinions of oncologists. According to a 2016 study by Gramling et al., 68% of patients had a different opinion about their survival prognosis than their oncologist. Moreover, only 10% of patients were aware of the difference in opinion.
A large percentage of patients with incurable cancer are apparently in denial. A study by Epstein et al. in the Journal of Clinical Oncology in 2016 showed that only 5% of patients with terminal cancer (they had less than 6 months to live) had a completely accurate understanding of their illness.
It appears as if neither party is willing to initiate a conversation about life expectancy and when it eventually takes place, patients are often too overwhelmed to properly process the information. There are a myriad of reasons why oncologists are not forthcoming about a negative prognosis. Examples include worrying about taking away a patient’s hope or making them depressed.
Neither party wants to have the conversation, which results in the patient discovering he/she has months to live. As a result, patients avoid asking, and oncologists are happy to go along with it.
Is Hype Replacing Hope?
There is a suggestion that the medical community is not as successful as perceived in the battle against cancer. This claim includes accusations against media outlets who supposedly exaggerate research findings, pharmaceutical companies selling drugs designed to increase life expectancy, and hospitals attracting paying customers with carefully targeted adverts that tug at the heartstrings
Of course, it is not all negative, and the success medical researchers have is worth celebrating. An increasing number of early-stage cancers are curable, but as of right now, there is a high mortality rate amongst those with advanced stage cancer. The United States spent $88 billion treating cancer in 2014, and this figure will skyrocket in the near future.
As cancer patients will do and pay just about anything to find a cure, and oncologists will try and help, there is needless spending in situations where there is no real hope of success. In a 2012 study published in The New England Journal of Medicine, 81% of patients with advanced colorectal cancer and 69% of patients with metastatic lung cancer believed a cure was possible. In both cases, the chance of survival is extremely low. For example, the five-year survival rate for metastatic lung cancer is 1%.
As well as offering false hope, the lack of reliable information causes patients to choose a painful treatment option that is pointless. The Dartmouth Atlas of Health Care reports that around one-third of cancer patients end up in the ICU during their last month of life. Tragically, many of them don’t realize how sick they are until the very end.
Not only do doctors and patients avoid talking about a cancer prognosis, but both sides also tend to be overly optimistic about the chances of survival and life expectancy. A study by Lamont and Christakis in 2000 showed that physicians correctly predicted a cancer patient’s life expectancy only 20% of the time. The majority of doctors got their prediction completely wrong; some predicted patients would live up to five times longer than they did.
Studies show that oncologists are often deliberately overly optimistic for the sake of their patients. Cancer doctors are also guilty of using medical jargon to confuse patients. Carolyn McClanahan spoke about how an oncologist told her mother, who was diagnosed with terminal liver cancer, that there was a 25 percent of her tumor ‘responding’ to chemotherapy. McClanahan’s mother believed this meant a 25 percent chance of a cure when in reality; the oncologist meant a 25 percent chance the tumor would shrink.
A 2001 study, later published in Kaiser Health News, said 40 percent of oncologists admitted to giving an inaccurate estimate of survival; most of them were overly optimistic.
When a patient discovers he or she has cancer, it is only natural to try to avoid the reality and paint as bright a picture as possible. However, ignorance is not bliss when it comes to cancer treatment. Patients must ask questions and learn where they really stand. Likewise, oncologists can’t continue ignoring the tough discussions; and they must provide as honest and accurate an assessment as possible, regardless of how grim the news is. Both doctors and patients must work together to find the best treatment plan.