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Should elderly patients be told they havecancer
- Arun Jha (19 November 2001)
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Our patients want to know the diagnosis - telling the truth to patients with cancer.
- Rachel Cooper (4 December 2001)
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Arun Jha, Consultant in Old Age Psychiatry Hertfordshire Partnership NHS Trust, Heme Logandene, Ashley Close, Hemel Hempst,Herttfordshi HP3 8BL
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EDITOR-Ajaj et al(1) have noted that disclosure of a diagnosis of cancer has on occasions caused conflict between physicians and family members . Their survey found over 70% of respondents wanted their relatives to be informed when the diagnosis of cancer was made. They claim to have clarified this issue, and they assert that it should help decision making in the difficult situation where family members ask that their elderly relatives should not be informed. However, this finding would not resolve the conflict between physicians and family members. Just because patients want their family members to be know their diagnosis does not mean the other way round. Family members would still ask that their relatives should not be informed. Clinicians dealing with dementia patients have been facing similar situation. Recent introduction of antidementia drugs has brought the problem to the surface. Clinicians have to make the diagnosis of Alzheimer’s disease before deciding whether the patients are eligible for these drugs. Who should know the diagnosis – patients or their family members? Does the disclosure of dementia cause any harm to the patient? A recent study(2) investigating the reaction of elderly patient has found that a high proportion (60%) dementia patients who also happened to be depressed, expressed an unfavourable view towards knowing their diagnosis. It is, therefore, logical to speculate that depressed cancer patients may not like to know their diagnosis. In Ajaj et al’s study, 28% did not wish their family to know. Clinicians will have to respect their patients’ wish. In situation where family members wish to withhold the information, clinicians should spend some time discussing the ‘ethical dilemma’ rather than perceiving the situation as a ‘conflict’. Patients have a right to be involved in decisions about their health care. This presumes that they have the mental capacity to make such judgements. Medical interventions must balance the risk of causing harm against the possible benefits (3). As acknowledged by the authors themselves, further study addressing this issue is now required to provide a ‘more comprehensive picture’. Arun Jha Competing interest: None 1 Ajaj A, Singh MP, Abdull AJJ. Should elderly patients be told they have cancer? Questionnaire survey of older people. BMJ 2001;323:1160. 2 Jha A, Tabet N, Orrell, M. To tell or not to tell-comparison of older patients’ reaction to their diagnosis of dementia and depression. Int J Geriatr Psychiatry 2001; 16:879-885. 3 Raanan G. Medical ethics: four principles plus attention to scope. BMJ 1994; 309:184-188. |
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Rachel Cooper, Assistant Professor in Radiation Oncology Dokuz Eylül University Hospital, Izmir, Turkey 35340
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Editor - Ajaj et al highlighted an important issue when treating patients with cancer, namely whether patients wish to know their diagnosis1. Not only age but also the patients and doctors cultural and ethic background may be an important factor with regards to telling patients their diagnosis and prognosis 2. The majority of information on disclosure of diagnosis has been derived from the developed world. Less is known about patients attitudes in the developing world where access to information is more limited and educational levels lower. To address this issue we performed a survey of 630 subjects attending health care centres for reasons other than a diagnosis of cancer in Izmir, Turkey. The median age of respondents was 35. Overall 84% of participants wanted to be informed if they were diagnosed with cancer and this proportion increased in those with a higher educational level. Interestingly however only 63% of participants wanted their relatives to be informed about a diagnosis of cancer. In Turkey, as in some other Southern European countries there is still a reluctance to inform the patient about a diagnosis of cancer on the part of both the physician and patients relatives 3. The usual reasons for withholding information include the patients inability to cope psychologically with the knowledge and the negative impact on treatment compliance. However, in a previous study of 120 patients with cancer undergoing radiotherapy treatment compliance was not affected despite 88% of patients being aware of their diagnosis 4. The use of more complex and toxic treatments with, in some cases, only a small potential benefit highlights the need to involve patients in decision making. The first step in this process is informing the patient of their diagnosis. While each patients information needs must be indıvidualised, it is important that clinicians approach the issue of disclosing the diagnosis of cancer with the patients actual, rather than perceived desire for information in mind. This actual desire may not be influenced by factors such as age and cultural or ethic background. Rachel Cooper Assistant Professor Riza Çetingöz Assistant Professor Mehmet Şen Professor Department of Radiation Oncology, Dokuz Eylül University, Izmir, Turkey.
1. Ajaj A, Singh MP, Abdulla AJJJ. Should elderly patients be told they have cancer? Questionnaire survey of older people. BMJ 2001;323:1160 2. Blackhall LJ, Murphy ST, Frank G, Michel V, Azen S. Ethinicity and attitudes toward patient autonomy. JAMA 1995;274:820-25 3. Thomsen OO, Wulff HR, Martin A, Singer PA. What do gastroenterologists in europe tell cancer patients? Lancet 1993;341:473-76 4. Şen M Communication with cancer patients: The influence of age, gender, education and health insurance status. Annals of the New York Academy of Sciences 1997;809:514-24. Competing interests: none |
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