Intended for healthcare professionals


Should elderly patients be told they have cancer? Questionnaire survey of older people

BMJ 2001; 323 doi: (Published 17 November 2001) Cite this as: BMJ 2001;323:1160

Our patients want to know the diagnosis - telling the truth to patients with cancer.

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
indývidualised, 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 Þen 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. Þen 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

Competing interests: No competing interests

04 December 2001
Rachel Cooper
Assistant Professor in Radiation Oncology
Dokuz Eylül University Hospital, Izmir, Turkey 35340