Talking to Your Doctor About Cancer

Talking to Your Doctor About Cancer

When cancer is the topic of discussion with your doctor the situation becomes filled with uncertainty and often anxiety. Just hearing the word cancer often evokes many strong emotions or vivid images. If someone has had a relative suffer with cancer just the word will bring strong emotions to the table. Imagery associated with cancer is often of someone losing their hair from chemotherapy or someone suffering in pain from a widespread cancer. Dying with pain is one of the biggest fears that most people have and becomes even more a consideration when faced with a discussion about cancer. The purpose of this article is to provide some structure and talking points for a discussion about cancer with your doctor. These same principles apply whether you are worried you may have cancer or your doctor expresses concern that a cancer might be present and wants further investigation performed.

Arriving at a diagnosis of cancer is never brief and a complete diagnosis and treatment plan requires a great deal of time. The waiting and process that is involved is often the worst part of it, even worse than hearing the final disposition because of the air of uncertainty. With a consideration of cancer or concern about cancer there are several key issues that must be addressed:

  • What are the chances I have cancer: Some symptoms which can be quite unsettling may actually have little to no risk of cancer. The media does a poor job of communicating useful facts about cancer. For example, bloody nipple discharge is a possible sign of breast cancer. A woman who has some nipple discharge with a tinge of red to it might immediately think she has breast cancer. This might also lead to additional feelings of grief, depression and despair. By the time the woman gets to see her doctor she been through quite a bit and may be very upset. Reassurance and reliable information is in order. Only a fraction of bloody nipple discharge indicates cancer (<5%), and most of the cancers that are present are very treatable and possibly curable. Considering this information, the finding of the bloody nipple discharge will not be as upsetting. A honest and open line of communication with your doctor should adequately address these concerns and help to answer this question in a more realistic way that is based upon facts and statistics rather than anxiety and misinformation.
  • What testing is needed: When a cancer is suspected, it is usually on the basis of a very concerning symptom, abnormal screening blood test, or some abnormal finding on physical examination. These cannot be ignored and deserve to be looked into to. A common example that all doctor are taught in medical school is not to overlook an older adult with anemia. Blood loss can occur with colon cancer and colon cancer is a common cancer in older adults. Thus routine blood work that shows anemia should prompt investigation for colon cancer if it has not already been done recently. There are many reasons that are not cancer why someone might have a slightly low blood count such as a problem with nutrition. Nevertheless, things like this deserve looking into. The patient might take away from the discussion of scheduling a colonoscopy that “they have or probably have colon cancer.” This is unfortunate but a common misperception. Having an appropriate concern and desire to detect a problem early should bring comfort and relief. Almost all cancers are quite treatable,  especially when discovered early. Thus a prompt study to follow-up a concerning finding such as the above is appropriate and reassuring.
  • Am I at risk for cancer: This is a very important question to ask because it changes how various symptoms are evaluated and also often changes the frequency with which tests are ordered. Someone who has had several relatives with lung cancer, who also has smoked cigarettes for many years, has an increased risk of getting lung cancer compared with the average person. In this type of person with elevated lifestyle and family risk factors, a symptom such as cough, pneumonia or a little blood in the cough would cause a higher level of concern than a person of average risk would. This person with elevated lifestyle and family risk factors would also be more likely to proceed to more definitive and invasive testing of symptoms with tests such as CAT scan of the lung or even bronchoscopy with tissue sampling (biopsies).
  • Can I reduce the risk of cancer: When someone is concerned about cancer it is also important to consider what can be done to decrease the risk of cancer. Cancer is a leading cause of death in the United States among adults. Some risk factors are non-modifiable such as a strong family history of breast cancer. Some risk factors can be modified such as lifestyle habits or medication therapy that might increase the risk for getting breast cancer. In this way, it is useful to understand what parts of cancer prevention you can take an active role in.

It is often useful to bring a spouse, close relative or even close friend with you for a discussion with cancer with your doctor. This is especially true if a long time block has been reserved and there is the possibility of bad news or test results. Many studies and much practical experience reinforces that people don’t process and receive information accurately in a stressful situation like this. Having a helping hand on board for both emotional support and to accurately relay information or help with writing it down is very useful.

REFERENCES:

  1. www.cancer.gov/cancertopics/factsheet/Support/prognosis-stats
  2. Delbanco TL. Enriching the doctor-patient relationship by inviting the patient’s perspective. Ann Intern Med 1992; 116:414.
  3. Impact of patient-reported outcomes in oncology: a longitudinal analysis of patient-physician communication. Takeuchi EE, Keding A, Awad N, Hofmann U, Campbell LJ, Selby PJ, Brown JM, Velikova G. J ClinOncol. 2011 Jul 20;29(21):2910-7. PMID:21690465
  4. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.