- Disclosure of the diagnosis to the patient?
Cancer is still a taboo in our society. Sixty to seventy percent family members come with the request not to utter the ‘word’. Though it is always better in longer run if you take your patient in confidence regarding the diagnosis as well as the disease extent or stage, but at times breaking the bad news is one of the most difficult aspects for the Oncologist too. Education, socio-economic status, cultural beliefs etc.also influences the timing and whom to announce the diagnosis. Commonly the bad news is first shared with family members, followed by announcement to the patient itself.
- Extent and Stage of the disease?
This is the next common and obvious query. Patient and family wants to know the stage of the disease. Your oncologist needs some time to examine, to go through the imaging, discussion with colleagues (not only fellow oncologists, but radiologists/pathologists/nuclear medicine physician) to understand the disease biology and spread, so as to put across the extent of malignancy in the body and hence the disease stage. One needs to be calm enough and avoid undue pressure on your doctor to arrive at a decision.
- Rate of cure and survival?
A million dollar question and so difficult to answer. Conversations about the disease prognosis are necessary to be fully informed about the likely course of disease and treatment. The prognosis depends on variety of factors like type of cancer, affected body part, grade of tumour, stage, other traits of the malignant tumor, age and performance status of the patient. Doctors estimate the cure or control of disease on the basis of statistics collected over many years in case series or trials in the similar set of patients. As the data is collected from a large group of patients and everyone is not same, nobody can predict exactly what’s going to happen to a particular individual suffering from cancer.
There are other issues which need to be discussed and would be covered in future articles. I presume that this write-up will help you to understand what to expect when you are visiting an oncologist and to be in sync with your doctor’s thought process.