Doctors can deliver hope as well as facts of prognosis

Commentary. By Julia Schopick, AMNews contributor. March 12, 2001.

Your patient is a 45-year-old professional man with no previous medical history. A lump in his neck caused his internist to refer him to you, an oncologist. The pathology report states that he has anaplastic thyroid cancer.

It is one of the rarest, deadliest forms of an extremely uncommon cancer. Much of the literature points to a grim prognosis, with a median survival of two years. Most doctors recommend chemotherapy and radiation, but the cancer usually returns. Still, except for the lump in his neck, he appears healthy -- and hopeful.

What do you tell him?

If you're like many physicians, you repeat the above prognosis almost verbatim. Many doctors, not wanting to give false hope, offer a basic bottom line of months or years. But this approach often doesn't take into account other variables.

For instance, many might not tell the patient that the fact that he is 20 years younger than the average ATC patient, and that he is in otherwise good health, bodes well for him. Many also might omit the fact that a median survival of two years means only that the middle person in a particular trial -- say, the 11th person in a 21-person study -- lived two years, but others lived longer, possibly much longer. They would simply say: "Mr. Patient, your prognosis is grim. According to the studies, the median survival is two years. I recommend radiation and chemotherapy, but the cancer will probably return." Still others would advise the patient to get his affairs in order and enjoy what time remains. [...]