“You have the good cancer.”
These are the most common words that spill out of providers’ mouths to patients just being diagnosed with papillary thyroid cancer. However, this statement does not make this diagnosis any easier to comprehend and digest the life-altering news that has been received by the patient. The survivability rate for this cancer is a high percentage; that is good news, but not good cancer. An issue at large is that 94 percent of patients who have this cancer have heard their diagnosis referred to as good cancer. Providers need to consider how this life-changing diagnosis impacts a patient’s life, even if the prognosis is not life-threatening, and apply better communication techniques.
Papillary thyroid carcinoma is on the rise. It often goes unnoticed. People can have it for years before being diagnosed. Once diagnosed, providers refer to papillary thyroid cancer as good cancer because it can be easily treated generally with a thyroidectomy, neck dissection of lymph nodes, hormone replacement therapy post thyroidectomy, radioactive iodine ablation, and/or alcohol injection ablation to lymph nodes.
Telling patients they have good cancer comes across as dismissive and downplays the patient experience involved with this diagnosis. This commonly used statement is paradoxical when caring for patients who have papillary thyroid cancer. Providers from any specialty need to consider the psychological and physiological effects that patients undergo from papillary thyroid cancer. Improving the delivery of news via effective and empathetic communication is imperative to practice.
Reflective case study
A new mom and then, six months later, a new cancer patient. A new life to love, but now challenged with loving her own life. Physical and psychosocial challenges during the postpartum period are still being overcome, but now they must face the difficulties of papillary thyroid cancer.
The patient must undergo major neck surgery. Recovering from a thyroidectomy and neck dissection can sometimes not go as anticipated. There are risks involved with operating in the neck region. Having good cancer invalidates this patient’s experience of an unexpected major surgery, postoperative recovery, and not having the full ability to care for their baby.
After surgery, the patient must prepare for radioactive iodine. The patient is breastfeeding and planned to for two years due to all the benefits for mother and baby, per the American Academy of Pediatrics recommendation. Unfortunately, I-131 is not safe for lactating patients. The lactating patient now must stop to allow the milk channels and ducts to dry up. If a breastfeeding patient does not allow their milk production to cease before ingesting radioactive iodine, then it can pose a risk for radiation to uptake in the mammary glands, which leads to a higher risk of developing breast cancer. Terminating breast milk production comes with risks, such as mastitis and impaired bonding with the baby. This “good cancer” has now affected a baby’s nutritional and emotional needs. The patient must not pump or breastfeed after the ingestion of radioactive iodine and is highly encouraged not to conceive for a year due to the risks of radiation consumption. Unfortunately, when consuming I-131, a patient is now radioactive and unable to be considered safe around children. The patient is required to isolate. How is this “good” for family dynamics?
After surgery, hormone replacement therapy is initiated because a patient cannot live without the thyroid hormone. Now the patient, who had no significant medical history, is on a brand-new daily medication for the rest of her life. If a dose is missed, it could result in unwanted side effects. This cannot be considered good.
Improve mindfulness and actions
Providers need to be aware of their communication regarding a sensitive life-changing diagnosis and stop referring to papillary thyroid cancer as good cancer. Every patient is different and requires individualized communication and care. Patients may not remember everything you tell them, but they will remember the way they were left feeling. They may cling to the words “This is good cancer.” but be left questioning the validity of that statement with every complication they face with papillary thyroid cancer. Even after remission, patients have been left with lifelong continuing supervision of their endocrine needs. This is a valid topic to promote awareness and advocate for the patients and future patients who suffer from this cancer. Telling patients they have good cancer is not a reassuring statement. It downplays the reality of what this diagnosis entails and the effect it can have on the patient’s life. Providers need to be able to communicate in a caring manner and pick up on cues to refer patients to necessary beneficial resources to help maintain the quality of life for the patient. This type of cancer these patients have requires a lot of management, and nothing about it is good.
Tresia Rouse is a nursing instructor and patient advocate.
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