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Journal of Clinical Oncology, Vol 26, No 19 (July 1), 2008: pp. 3293-3294 © 2008 American Society of Clinical Oncology. DOI: 10.1200/JCO.2008.17.4979
Just Say CancerDivision of Oncology, Cancer Center, V. Fazzi Hospital, Lecce, Italy
Psycho-Oncology Project, Associazione A. Serra, Lecce, Italy
Associazione Nazionale Tumori Italia Foundation, Lecce, Italy
Division of Oncology, Cancer Center, V. Fazzi Hospital, Lecce, Italy To the Editor: In a recent article entitled "Just Say Die," Dr Berry1 suggests reintroducing words like death and dying into physicians’ conversations with patients to improve relationships with patients, to help discussions about death, and finally to take better care. Barriers to end-of-life conversations can seriously interfere with the decision making and quality of life for patients with advanced cancer and a short life expectancy.2 We recently reviewed medical charts of patients with cancer with a short life expectancy in the Lecce area in southern Italy, between January 2005 and December 2007. Patient awareness in diagnosis was recorded as "not informed and he/she did not know" in 78 (41%) of 188 patients. A common issue in southern Europe, Japan, and Asia involves truth telling (giving bad news regarding cancer diagnosis or prognosis).3 Moreover, frequently families are given the negative information before the patient is informed. This creates ethical-legal issues affecting informed consent and patient decision making.4,5 In order to lessen and even abolish this improper situation, it appears as fundamental to initiate from diagnosis to give correct and complete information suited to the patient's cultural, psychological, and social level. The end is the perfection of the beginning, so before we "just say die", we need to "just say cancer." Oncologists are not routinely trained in the psychosocial aspects of patient care, and then may not be equipped to effectively disclose negative information regarding cancer diagnosis, disease recurrence, and end-of-life issues. Back et al6 reported results of a communication skill workshop: while 16% of participants used the word cancer when giving bad news before the workshop, 54% used it after the workshop. Physicians are making progress in talking to their patients about conversations, but a review of the literature suggested no physician can successfully undertake all aspects of this challenge.7 Many factors concerning the information/communication process may underlie the physician's behavior: the physician may not be able to inform, the physician may choose not to be fully honest in an attempt to preserve hope, the physician may not inform the patient because the patient is unable to accept what the physician is saying. Moreover, as showed by Panagopoulou et al8 in a recent article, the physician may not provide correct information so as to avoid his own emotional distress. In our opinion, it's time to take a step forward in performing ongoing conversations with the support of professional figures specialized in this area, such as psychologists/psycho-oncologists, that can assist the patient with advanced tumor to receive correct information, to support his decision making, and to approach death in accord with his values and wishes. Workshops and clinical training should be organized to better integrate this combined approach. In conclusion, we agree with Berry1 and Panagopoulou et al8 about the importance to improve our communication skills and to use a frank and honest language with our patients. However, the information/communication process needs of a combined approach to effectively disclose negative information from diagnosis until the end-of-life, from "just say cancer" until "just say die". AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. REFERENCES 1. Berry SR: Just say die. J Clin Oncol 26:157-159, 2007[CrossRef] 2. Earle CC, Neville BA, Landrum MB, et al: Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315-321, 2004 3. Miyashita M, Hashimoto S, Kawa M, et al: Attitudes towards disease and prognosis disclosure and decision making for terminally ill patients in Japan, based on a nationwide random sampling survey of the general population and medical practitioners. Palliat Support Care 4:389-398, 2006[CrossRef][Medline] 4. Back AL, Arnold RM, Tulsky JA, et al: On saying goodbye: Acknowledging the end of the patient-physician relationship with patients who are near death. Ann Intern Med 142:682-685, 2005 5. Grassi L, Travado L, Gil F, et al: A communication intervention for training southern European oncologists to recognize psychosocial morbidity in cancer: I—Development of the model and preliminary results on physicians’ satisfaction. J Cancer Educ 20:79-84, 2005[CrossRef][Medline] 6. Back AL, Arnold RM, Baile WF, et al: Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Arch Intern Med 167:453-460, 2007 7. Larson DG, Tobin DR: End-of-life conversations: Evolving practice and theory. JAMA 284:1573-1578, 2000 8. Panagopoulou E, Mintziori G, Montgomery A, et al: Concealment of information in clinical practice: Is lying less stressful than telling the truth? J Clin Oncol 26:1175-1177, 2008
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Copyright © 2008 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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