The unspoken sentiment towards patients with advanced cancer

The unspoken sentiment towards patients with advanced cancerI have been thinking about the cancer experience—what it must be like to be on the receiving end of a cancer diagnosis, to live with cancer, and to experience the treatments; to receive the news that treatment worked or that it didn’t. I also have been thinking about what it must be like to “carry” a diagnosis of cancer around. When I began in oncology, I never gave much thought about the use of a cancer diagnosis to characterize my own patients, particularly when discussing them among colleagues. “Do you know my leiomyosarcoma patient, Mrs. X?”

I often wonder if this happens outside of the clinic? When my patient goes home and resumes her role as a member of a wider social network (as mother, daughter, co-worker), has cancer become a “label”? Is it permanently associated with her? When her friends speak about her, do they use the same “diagnosis as descriptive”?

“Do you know my breast cancer friend, X?”

I have come to realize that while the use of a cancer diagnosis to describe a patient is common, it can also trigger assumptions that may not be correct, which may result in terrible consequences. Beyond the care and compassion rendered in oncology practices throughout the world, there may be an unspoken sentiment within society and within other realms of medicine that treats patients with advanced (or chronic) disease as “hopeless” or “terminal,” regardless of where they are in their disease state.

I recall a patient under my care that developed shortness of breath and fevers at home. She required emergency evaluation and was brought to a local ER.

“Is this metastatic ovarian cancer patient under your care?” the ER resident had asked me.

“Yes,” I said. “I am Mrs. ___’s oncologist.”

“She has pneumonia and she is pretty sick. The cancer is metastatic, so I assume she is DNR?”

“No, she isn’t a DNR. Just because her cancer is metastatic doesn’t imply she is terminal. You understand this right? Patients with cancer get pneumonia too. Please do all that you can to get her through this,” I replied.

I have since learned to emphasize a patient’s clinical status first, then their diagnosis. I have also made it a point to teach our fellows that it is our patients who have cancer, and they should not be perceived as “cancer patients.” Cancer is a noun, not an adjective, and perhaps it should not be used as such.

On a practical point, I have discovered doing so makes a difference. When sending patients to urgent care, I describe them functionally first, then give the history: “Mrs. ___ is a 48-year-old mother who works part-time, with a performance status of 80%. She is being treated for metastatic ovarian cancer.” I find I argue less with those on the other end of the phone call to get the appropriate level of care for my patients with cancer.

In an ideal world, all of us are defined by who we are, who we love, our passions, and our accomplishments. I do not believe any of us should be described by whatever medical condition we happen to face. In oncology, it is an ideal that we should embrace, to ensure quality care for those who have entrusted us, literally, with their lives.

Don S. Dizon is an oncologist who blogs at ASCO Connection, where this post originally appeared.

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