Wow. “Nearly 4 of 10 Americans believe cancer can be cured solely through alternative therapies.” Here’s my response to clinicians.
(excerpt from An ASCO Survey, Hope, and Conventional Therapies)
HOW DO YOU respond when patients with a good prognosis want to delay chemotherapy to try an anticancer diet for a few months or visit an unregulated clinic for unproven therapies? ….
I’ve been thinking about this issue since my days in medical school in the late 1970s. During an externship in oncology, I witnessed the frustration of physicians and nurses when a patient with treatable disease skipped therapy to fly to Mexico for the alternative treatment commonly known as Laetrile….My bewilderment convinced me that, along with learning to diagnose and treat disease, I needed to learn how to talk to patients about therapies.
Conventional vs Alternative Therapies: How We Talk About Hope
…my cancer recurred a second time. My treatment options narrowed, my prognosis worsened, and my hope of survival waned. With three young children at home, I began reading about alternative cancer “cures” with the mind of a scientist and the heart of a mother desperate to survive.
…As a patient, I experienced how invitations to try alternative “cures” stirred my hope in ways discussions of conventional therapies did not. For one thing, those pitches supported their claims with stories, not statistics. Because our perception of our future affects our hope, the happy-ending testimonials fueled my hope by providing templates for envisioning my own happy survival. In contrast, conventional therapy’s focus on statistics highlighted the uncertainty, which intensified my fear.
In addition, feeling hopeful about a variety of desires may stir a general sense of hopefulness. The ads for alternative therapies encouraged me to hold on to many of my hopes, such as the hope to avoid toxicity and the hope to minimize disruptions in my life. Conventional medicine, with its focus on efficacy, seemed to demand I let go of those hopes—losses that increased my sense of vulnerability and impotence.
…The realization that made all the difference was this: more than I hoped to avoid toxic treatments, I hoped to get the treatments that gave me the best chance.
Mixing in Hope With Facts and Statistics
REFLECTING ON my interactions with my patients, I wonder whether the problem was that I never mentioned hope in my discussion of the facts and statistics about treatment options. After all, hope drives patients’ actions. I now believe I would have done better to begin the discussion of treatment options by asking, “What are you hoping for?” Patients’ answers would have provided a back door to insights about their goals of care.
Then I could have asked my patients to prioritize their hopes: “Of all the things you’re hoping for, which are your top one or two?”
…To address patients’ fears about toxicity, I could have added, “We will take steps to keep your treatments as safe as possible without compromising their ability to help you.”
…As a segue to a discussion of treatment options, I could have said, “I am hoping for the best possible outcome for you.”
…The 2018 ASCO National Cancer Opinion Survey documented an epidemic of false hope. Talking with patients about hope before presenting treatment options may help them hear and weigh the facts and statistics needed to make informed decisions. I’m not suggesting this approach will solve the problem. I’m offering it as one way to start conversations that help patients experience the realistic hope of conventional therapies. ■ (complete article at ASCO Post)
1. American Society of Clinical Oncology: National Cancer Opinion Survey. October 2018. Available at www.asco.org/research-progress/reports-studies/national-cancer-opinion-survey. Accessed May 29, 2019.
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