Posted: October 10, 2012

In this week’s New England Journal of Medicine, Weeks et al from Dr. Stark’s alma mater, the Dana Farber Cancer Institute, published a revealing study in which patients with metastatic lung and colon cancer were polled about their expectations from chemotherapy.  You can view the article here.   A stunningly high percentage of patients expected to be cured.  The authors and the accompanying editorial by Tom Smith and Dan Longo, keen long-time observers on the Oncology scene, go into reasons for this, not the least of which is their theory that Oncologists curry favor with their patients and therefore provide unrealistic expectations for success.  Dr. Stark comments, “It was often difficult for me to try to figure out what patients wanted to hear or were ready to hear about their prognosis.  Many seemed to know at a sub-verbal level.  Some of the so-called mis-communication in this article probably stems from a reluctance on the part of the Oncologist not to overload the patient with bad news — not to curry favor but out of sympathy.   Dealing with this issue was always the elephant in the examining room.  The medicine itself was pretty straight-forward.”