What not to say if you’re a cancer surgeon



It’s a common scene: A patient recovering from cancer surgery speaks with their surgeon, who reassures them the procedure went well and that doctors “got it all.”

But those three words can sow serious misunderstandings and even medical mistrust, suggest the authors of a recent viewpoint article in JAMA Oncology.

The problem lies in a disconnect between surgeons’ “got it all” phrasing and their patients’ expectations, a group of bioethicists and surgeons write, because patients may think that, if all visible tumor tissue has been removed, they are cancer free — and that might not be the reality.

Although cancers can be completely removed through surgery, cancer cells can also spread to lymph nodes and other parts of the body despite tumor removal, and follow-up chemotherapy might be necessary. Even when a tumor is removed, only pathology can confirm that there is no cancer in the lymph nodes.

Because of its plain-English simplicity, “got it all” is unlikely to be questioned by patients, the researchers suggest. The writers of the paper worry the phrase could prompt patients to refuse chemotherapy when they receive a later confirmation that there is cancer in their lymph nodes.

Cancer patients face identity changes through diagnosis, treatment

Other research has found that cancer patients tend to be optimistic about surgery as a potential cure for their cancer. One 2015 study of 3,954 patients who had cancer surgery found that about 80 percent of those with lung cancer and 87.5 percent of those with colorectal cancer thought surgery would cure them, despite differing prognoses for people with those diseases. That perception even applied to the majority of respondents with Stage 4 cancers that had spread to the lymph nodes.

Ultimately, though, cancer surgery usually serves two purposes: therapy and diagnosis.

“Because patients primarily hear about surgery as being therapeutic, they are primed not to consider the diagnostic function of surgery,” according to the article. The writers say surgeons should watch their words — or risk disappointing or misleading patients.



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