The “cure” word and its use … by oncology specialists and their patients


As many readers will be aware, the word “cure” has to be used with caution in talking about any form of cancer — prostate cancer included. While “curative” therapy can be offered to a high proportion of men diagnosed with this condition, achieving a true “cure” is a less predictable opportunity, especially for men diagnosed with intermediate- and high-risk disease.

In this context, there is an interesting article in this month’s Journal of Oncology Practice. It deals specifically with the use of the word “cure” in the management of cancer by physicians working at the Dana-Farber Cancer Institute in Boston, Massachusetts (rightly regarded as one of the pre-eminent cancer centers in the USA).

Use of the word “cure” in cancer care reflects a balance of physician and patient optimism, realism, medico-legal concerns, and even superstition. This study surveyed a group of oncology specialists regarding the frequency and determinants of using the word cure.

Miller et al. invited 180 specialist oncology clinicians at Dana-Farber to complete a 19-question survey dealing with such matters as how commonly their patients are cured, how often they use the word cure in their practice, and details about its use.

The authors provided three clinical case scenarios to elicit participants’ views as part of the survey. These case scenarios gave information about patients who were 20-year survivors of testicular cancer, large-cell lymphoma, and estrogen receptor-positive breast cancer. While none of the questions or the case scenarios dealt with advanced or metastatic forms of prostate cancer, some of the learnings are still instructive:

  • 117/180 invitees (65 percent) actually responded to the survey.
  • Of these actual survey respondents
    • 95/117 (81 percent) were hesitant to tell a patient that he or she had been cured.
    • 74/117 (63 percent) would never tell a patient that they are cured.
    • Only 8/117 (7 percent) felt that > 75 percent of their patients are, or will be, cured.
  • The survey participants further reported that only 34 percent of their patients actually ask if they are cured.
  • In the case of the 20-year survivor of testicular cancer
    • 84 percent of clinicians believed that the patient was cured.
    • 35 percent of clinicians still recommended annual oncology follow-ups.
  • In the case of the 20-year survivor of large-cell lymphoma
    • 76 percent of clinicians believed that the patient was cured.
    • 43 percent of clinicians still recommended annual oncology follow-ups.
  • In the case of the 20-year survivor of estrogen receptor-positive breast cancer
    • 48 percent of clinicians believed that the patient was cured.
    • 56 percent of clinicians still recommended annual oncology follow-ups.
  • 23 percent of oncology clinicians believed that patients should never be fully discharged from the cancer center.

It seems very clear that specialized oncology clinicians (at least at Dana-Farber)are hesitant to use the “cure” word for many of their patients, and that their patients are hesitant to ask whether they are cured.

Obviously, from the point of view of many of the readers of this blog, it would have been nice if advanced (but perhaps non-metastatic) prostate cancer had been used as one of the case scenarios.

3 Responses

  1. Well before I got prostate cancer I was hesitant to use the word “cure” when discussing cancer. I also never used “in remission,” since I do not know the exact meaning of the word. Today, I use phrases like “nothing detectable right now,” or “nothing detectable since my last exam.”

  2. My PSA scores have been 8.0, 3.0, 1.0, 1.0, 1.0, 0.1, < 0.1, < 0.1, and < 0.1 ng/ml.

    In addition, my erections are still there, I have no pain except for mild flashes, and I do daily sessions of weightlifting.

    How am I doing? Please advise.

    George

  3. Dear George:

    Since we don’t know a whole bunch of other stuff about you (e.g., the dates of these PSA tests, your age, your original diagnosis, when you were treated, how you were treated, etc.), it is quite impossible for us to comment on “How you are doing” in any meaningful way. However, assuming you were originally diagnosed with relatively low-risk, early stage prostate cancer and treated either surgically or with radiation therapy, you certainly appear to be doing just fine.

    If you were to join our social network and provide additional information, then it would be possible to offer some more educated comment in response to your question.

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