Cancer is something we all fear, and with very good reason. Unlike most diseases, there are many different types of cancer and it can affect any part of the body. Worse still, cancer has the ability to spread (metastasize), and this makes it very difficult to cure.
Cancer also has a way of sneaking up on people and can be in an advanced stage before a person even becomes aware they are ill. Due to this, a cancer diagnosis can often come with a poor prognosis, and doctors are faced with the unenviable task of passing the sad news onto their patients and their families.
The word “prognosis” comes from the ancient Greek, meaning “foreseeing or foreknowledge.” This is what doctors rely upon when they are dealing with a person who has cancer.
Extensive research into the causes and types of cancer, plus their treatment and survival rates, has been carried out over a period of many years, and the documented evidence that comes from this research is what doctors use to help them determine the expected outcome of a person who has been diagnosed with cancer.
Depending on which type of cancer they have and the stage (spread) of the cancer, doctors determine the average survival rate of patients who have suffered from the same type of cancer in the past and then predict a possible life expectancy for the newly diagnosed cancer patient.
No matter who we are, there is one truth in life that we cannot avoid, and this is the fact that no one can live forever. Like it or not, we must all accept that there will come a day when our life comes to an end.
Accepting that we are going to die someday is one thing; being told when this event is likely to happen is an entirely different matter.
“You are dying” is the cruelest thing that anyone could say to another person, and this is exactly what a doctor is saying to a patient when he or she gives a terminal diagnosis, followed by a prognosis of how long a person is expected to live.
Whether the prognosis is for one month, six months or a year, the emotional impact for the patient and their loved ones is the same, and from that point onward, the thought of impending death weighs heavily on their mind.
And this brings the question of prognosis to the forefront: When someone has been diagnosed with an incurable cancer, do they really need to be told when they are expected to die?
The answer to this question is no; there is no law that states that a doctor has to give a terminally ill patient an estimate of how long they have to live. The fact remains that no matter whether they tell the patient or not, it will not make a difference in the outcome.
This aside, there are cancer patients who want to know how long they are expected to live and will request this information from their doctor.
Their reasons for wanting to know their life expectancy can be varied, but most often it is because they want to put their affairs in order.
On the other hand, there are also cancer patients who do not wish to know how long they are expected to live and have no intention of asking the doctor for this information.
The reasons for patients not wanting to know their prognosis can also be varied. It could be that they are not yet ready to accept that they are dying and choose to live in hope of a cure. Or it could be that they accept that they are going to die from their disease eventually, but don’t want the expected time of their death to be hanging over their head.
Cancer is most certainly a disease from which many people are suffering, however each and every one of them is an individual and no two people will deal with a cancer diagnosis in the same way.
For this reason, I believe that every cancer patient should be given the opportunity to decide whether they wish to know how long they are expected to live.
If a doctor gives his or her opinion of this without first asking the patient what their wishes are, they are robbing the patient of the ability to choose, and this can dramatically affect how they deal with their terminal diagnosis.
One person who definitely did not want to be told how long he had to live was my husband, Brian, yet he was brutally told this at the time of his mesothelioma diagnosis. While I can accept that telling a patient there is no cure for their disease can never be easy, I believe that doctors need to show compassion and respect for those who are receiving this tragic news.
Brian’s prognosis shattered us, and the range of months he was given made it even worse. “Three to nine months, I reckon,” was a brutal way to learn that Brian was dying.
Not knowing if Brian would live for three months, nine months or somewhere in between was the cruelest torture. We could not get the thought of his impending death out of our minds. It was impossible not to count down to the time when he was expected to die, and we saw every passing day as bringing us even closer to it.
When nine months had passed, Brian said to me, “I have proven them wrong; this cancer is not going to beat me.”
No longer having the date of his expected death hanging over his head, Brian had found hope, and the change in his emotional well-being was wonderful to see.
Contrary to his prognosis of three to nine months, Brian lived for two years, which is testament to the fact that prognosis is only a doctor’s opinion and is not necessarily correct.
The hardest thing for me to bear when I was caring for Brian during his mesothelioma illness was that there was no cure for this disease, and that because of this, there was no hope for a future together.
Despite this, I instinctively knew that Brian needed to live in the hope that he would survive, and I supported him in this at every opportunity.
Hope is a vital component for people who are living with cancer, and even when the hope of survival is no longer possible, patients can still hope that their remaining life will be free of pain and that they will be comforted and supported as they face their death.
By being intuitive, doctors can learn a lot about the way cancer patients deal with their cancer diagnosis and find better ways to support patients and their families at these distressing times.
It is important for them to understand that although they may not share a patient’s hopes, they should nonetheless respect them.
Perhaps the best way for doctors to deal with the difficult issue of prognosis is to heed the advice of Dr. Elisabeth Kubler-Ross, one of the foremost authorities in the field of death. On the topic of prognosis, she says:
“You have to be honest, but you don’t have to be totally honest. You have to answer their questions, but don’t volunteer information for which they have not asked, because that means that they are not ready for it yet.
“Without miracles, there are many, many ways of helping somebody without a cure. So you have to be very careful how you word it. And never, ever take hope away from a dying patient. Without hope, nobody can live.”
