Tell cancer patients truth

By Yoon Ja-young

Park, a housewife in Daejeon, lost her husband last year. He was diagnosed with pancreatic cancer. When the doctors opened her late husband’s abdomen, they found that the cancer had progressed much more than they estimated. They had to suture without performing surgery.

The wife, however, didn’t tell her husband what had happened. The patient believed that the surgery was successful, and was told the truth only at the moment he was passing away.

Cases like Park’s are still common in the country. The family hesitates telling the terminal-stage cancer patients their exact condition. A research, however, showed that not only the frank talk helps decision making but it also enhances the quality of death.

Prof. Ahn Eun-mi and Prof. Shin Dong-wook at the Seoul National University Hospital and a research team at National Cancer Center announced the report after analysis on 345 terminal cancer patients who were hospitalized in the palliative care centers.

The study showed that only two out of three patients knew of their condition when they arrived at the centers. After these patients passed away, the research team made the family evaluate the quality of the death, using “good death inventory.” The index comprises 18 factors, such as physical and psychological comfort, dying in a favorite place, maintaining hope and pleasure, and good relationship with staff or the family. The patients who knew of their condition scored higher than the patients who didn’t. They especially scored higher in terms of “control over the future” and “maintaining hope and pleasure.” They also were likely to have less conflict with the family in building treatment plans.

“In Asian cultures, family members often believe that it is a filial responsibility to keep burdensome information from patients and to make end-of-life decisions on behalf of the patient. Consequently, surrogate decision making frequently occurs and often leads to more aggressive life-sustaining treatment,” the research team noted.

“It seems natural that the awareness of a terminal illness improves the quality of death, especially in domains such as control over one’s future, maintaining independence, dying in a favorite place, preparation of death, and life completion because these domains reflect the patients’ own decisions and existential issues,” it added.

The research team noted that the patients who knew it all were also better maintaining hope and pleasure, contrary to the usual expectations in Asian cultures.

“One possible explanation is that the awareness of terminal illness leads to the opportunity for the patients to have a more realistic hope, instead of losing hope. It has been reported that even though family members have tried to shield patients from the reality of their situation, almost 30 percent of advanced cancer patients eventually guess their prognosis from their worsening condition and thus ultimately experience more emotional distress than patients informed of their terminal diagnosis.”

The research was supported by the National R&D program for cancer control and was published in the latest edition of “Psycho-Oncology,” an international journal.