Patients rarely regret optimism

EDITOR—Imminent death is not the inevitable consequence of a diagnosis of small cell lung cancer, as The et al say in their paper.1 They are wrong in saying that life expectancy is a maximum of two years. A recent analysis of patients on the National Cancer Institute's database showed a five year survival of 12.2% in patients with limited stage disease.2 Remission and prolonged survival can be achieved only by active treatment with chemotherapy and radiation, and yet The et al report that patients familiar with the plight of incurable cancer refused treatment. This will certainly have compromised the survival of those patients, and yet it seems that The et al are advocating that all patients should be similarly persuaded of the hopelessness of their situation.

It remains true, however, that most patients will die of their disease within two years, but we believe that the false optimism that is reported is not a problem that needs to be overcome. It is a common coping strategy adopted by patients who, as The et al describe, often do know but cope by putting on the appearance of not knowing their prognosis. This allows them to lead their lives as fully as possible. It is not helpful and certainly not compassionate to insist that patients openly acknowledge their poor outlook. The et al …