The C word
No, not that C word.
And not ‘Chope’ either, though goodness knows his antics and those of his filibustering friend have made me furious over the last few days.
The C word this blog post is about is cancer.
A few days ago I noticed this tweet – and it moved me sufficiently to object. (There’s that O word again – but I promise this isn’t going to turn into a rant about Chope).
If you’re talking to a patient about a potential cancer diagnosis, you HAVE to say the word cancer.
Not tumor, not malignancy, not mass, not leukemia, not lymphoma.
Don’t dance around it. #tipsfornewdocs
— Emily Fridenmaker (@emily_fri) June 14, 2018
I’m all for doctors being honest with their patients. And on reflection, telling someone they have a tumour, malignancy or mass isn’t helpful. It’s definitely avoiding the issue. But so is always using the word cancer in a diagnosis conversation.
Cancer covers a vast number of different diseases, each with their own unique challenges. Saying ‘you have cancer’ to a patient is about as useful as telling people with (say) liver cirrhosis, heart disease or a kidney infection that they have an ‘organ problem’.
In my own experience, the specificity of the discussion I had on first diagnosis (firstly around lymphoma, then the specific type, followed by the treatment options) was far more important than the use of the C word. I think the use of the C word might even have been counter-productive in my case – it would have terrified me. To be honest, I don’t believe that any of my consultants have ever used the C word in conversation with me, and I’m glad that they haven’t.
The unhelpful stereotypes that the word cancer induces would probably have stopped me from listening. It certainly wouldn’t have helped with my decision to go on watch and wait. After all, the cancer treatment stereotype most common in public discourse is that treatment should always be immediate. In the early days, I lost track of the number of times I had to convince friends and colleagues that immediate treatment, in my case, was unhelpful. However, talking about my condition as lymphoma rather than cancer (or even blood cancer) helped people to understand that what I was facing was a little different to the usual cancer stereotype.
Now, I’m certain that different people will react differently to this. If there’s one thing that being a lymphoma patient has taught me is that everyone reacts differently to the news – and to their treatment programmes.
So my revised #tipsfornewdocs would be to make time to have a proper discussion with your patient about their diagnosis. Take time to understand what they already know, and what they don’t know. Definitely don’t beat about the bush – just talking about a mass, malignancy, tumour or even cancer is not enough. Be specific. But do use terms like lymphoma or leukemia if that’s what they have. Explain the consequences and treatment options for the diagnosis. And if the C word isn’t helpful in describing these, don’t feel the need to use it.