When The Doctor Gives Too Much Info
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15/10/2009
Print Article >> Back to the article Oct 15, 2009 When doc gives too much info Patients deserve to know about their illness and treatment options but too much information can add stress and confuse them By June Cheong
Knowledge empowers - especially when you are dealing with disease. 'One thing that disease does to you is to make you lose control. One thing information does is help you regain your sense of control,' said Dr Justin Stebbing, a consultant medical oncologist at Charing Cross Hospital in London. While knowing more about one's condition is essential, a question that has plagued the medical fraternity is: What is too little or too much information? Professor Bernard Nordlinger, chairman of the department of oncology and surgery at the Hopital Ambroise Pare in Paris, said: 'There are patients who want to know everything but after they do, they regret it. 'There's growing pressure for patients to be involved in their treatment decisions but some may not want all the information. The doctor should explain what is practical for the patient but must not stress him out.' This topic was the subject of a media debate in Berlin at a major European oncology conference in the German city last month. The issue is particularly pertinent to the area of oncology. Dr Kong Hwai Loong, a medical oncologist at H L Kong Medical Oncology Centre, who attended the conference, said: 'In the old days, cancer patients grappled with the difference between radiotherapy and chemotherapy. 'In the last 10 years, cancer biology and cancer treatment has greatly expanded in scope and complexity. There are so many new cancer drugs nowadays.' Take colorectal cancer, for example. Since the late 1990s, when research pointed to the essential role of the KRAS gene in tumour development and maintenance, scientists have identified KRAS as a biomarker to predict a patient's response to certain drugs. KRAS is a gene that codes for one of the proteins contributing to the development and growth of cancer. The status of a patient's KRAS protein is especially useful in predicting whether he will benefit from targeted therapy using Erbitux. This drug is a monoclonal antibody which inhibits the cancer cell's signalling process and effectively blocks downstream effects like cell proliferation. Those with a 'wild type' or non-mutated KRAS protein have been found to respond favourably to Erbitux while those with a mutated KRAS protein do not respond well to the treatment. Last month, researchers found that the risk of death for suitable patients who received Erbitux and chemotherapy was reduced by 19 per cent and risk of disease progression was reduced by 34 per cent. Professor Heinz-Josef Lenz, a professor of medicine and preventive medicine at the division of medical oncology in Keck School of Medicine at the University of Southern California, said: 'By tailoring treatment, we can save patients time and money and from suffering side effects.' While the proliferation of treatment therapies is said to be good news for cancer patients, more choice means more patient education is needed. Prof Nordlinger said: 'If you tell a patient he has a mutated KRAS tumour, he may not understand it.
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15/10/2009
'The patient must have information. But how much do you tell him? Cancer treatment options are a scientifically complex subject that even physicians may have difficulty with.' Dr Lim Siew Eng, a senior consultant at the department of haematology-oncology at the National University Cancer Institute, Singapore, said: 'There is more emphasis on providing information so patients can participate in the decision-making process. 'But this has to be balanced against putting an undue burden of responsibility on the patients.' Dr Kong said: 'Patients have many layers of fear so we have to simplify complex medical jargon to the point that patients and their caregivers can easily digest the information.' He takes his patients through a slideshow about their cancer and treatment options. He then sends them home to think over the options before they return to see him and decide on a course of treatment. He also encourages his patients to take their family members and friends to the consultations so they can generate more questions and help the patients remember the information being given. Dr See Hui Ti, a senior consultant in medical oncology at Parkway Cancer Centre at Mount Elizabeth Hospital, emphasised the need to adapt the information to the patient's understanding. She said: 'Giving information in bite sizes allows patients to understand their condition and enables us to partner them in treatment decisions. Too much information at one go may confuse them and cause a delay in life-saving treatment.' Dr Stebbing added: 'It's a question of giving out the right amount of information at the right time. Patients only remember a portion of what you tell them. The message needs reinforcement from time to time.' One patient who has benefited from her doctor's slow and steady approach is Madam Lim Meng Choo. The 60-year-old executive secretary who was diagnosed with Stage 4 colon cancer in June said: 'My doctor was very forthcoming and told me what should be done for my case. He laid out my treatment options but the decision lay with me.' [email protected] Copyright © 2007 Singapore Press Holdings. All rights reserved. Privacy Statement & Condition of Access
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Page 2 of 2
Print Article >> Back to the article Oct 15, 2009 When doc gives too much info Patients deserve to know about their illness and treatment options but too much information can add stress and confuse them By June Cheong
Knowledge empowers - especially when you are dealing with disease. 'One thing that disease does to you is to make you lose control. One thing information does is help you regain your sense of control,' said Dr Justin Stebbing, a consultant medical oncologist at Charing Cross Hospital in London. While knowing more about one's condition is essential, a question that has plagued the medical fraternity is: What is too little or too much information? Professor Bernard Nordlinger, chairman of the department of oncology and surgery at the Hopital Ambroise Pare in Paris, said: 'There are patients who want to know everything but after they do, they regret it. 'There's growing pressure for patients to be involved in their treatment decisions but some may not want all the information. The doctor should explain what is practical for the patient but must not stress him out.' This topic was the subject of a media debate in Berlin at a major European oncology conference in the German city last month. The issue is particularly pertinent to the area of oncology. Dr Kong Hwai Loong, a medical oncologist at H L Kong Medical Oncology Centre, who attended the conference, said: 'In the old days, cancer patients grappled with the difference between radiotherapy and chemotherapy. 'In the last 10 years, cancer biology and cancer treatment has greatly expanded in scope and complexity. There are so many new cancer drugs nowadays.' Take colorectal cancer, for example. Since the late 1990s, when research pointed to the essential role of the KRAS gene in tumour development and maintenance, scientists have identified KRAS as a biomarker to predict a patient's response to certain drugs. KRAS is a gene that codes for one of the proteins contributing to the development and growth of cancer. The status of a patient's KRAS protein is especially useful in predicting whether he will benefit from targeted therapy using Erbitux. This drug is a monoclonal antibody which inhibits the cancer cell's signalling process and effectively blocks downstream effects like cell proliferation. Those with a 'wild type' or non-mutated KRAS protein have been found to respond favourably to Erbitux while those with a mutated KRAS protein do not respond well to the treatment. Last month, researchers found that the risk of death for suitable patients who received Erbitux and chemotherapy was reduced by 19 per cent and risk of disease progression was reduced by 34 per cent. Professor Heinz-Josef Lenz, a professor of medicine and preventive medicine at the division of medical oncology in Keck School of Medicine at the University of Southern California, said: 'By tailoring treatment, we can save patients time and money and from suffering side effects.' While the proliferation of treatment therapies is said to be good news for cancer patients, more choice means more patient education is needed. Prof Nordlinger said: 'If you tell a patient he has a mutated KRAS tumour, he may not understand it.
Page 1 of 2
15/10/2009
'The patient must have information. But how much do you tell him? Cancer treatment options are a scientifically complex subject that even physicians may have difficulty with.' Dr Lim Siew Eng, a senior consultant at the department of haematology-oncology at the National University Cancer Institute, Singapore, said: 'There is more emphasis on providing information so patients can participate in the decision-making process. 'But this has to be balanced against putting an undue burden of responsibility on the patients.' Dr Kong said: 'Patients have many layers of fear so we have to simplify complex medical jargon to the point that patients and their caregivers can easily digest the information.' He takes his patients through a slideshow about their cancer and treatment options. He then sends them home to think over the options before they return to see him and decide on a course of treatment. He also encourages his patients to take their family members and friends to the consultations so they can generate more questions and help the patients remember the information being given. Dr See Hui Ti, a senior consultant in medical oncology at Parkway Cancer Centre at Mount Elizabeth Hospital, emphasised the need to adapt the information to the patient's understanding. She said: 'Giving information in bite sizes allows patients to understand their condition and enables us to partner them in treatment decisions. Too much information at one go may confuse them and cause a delay in life-saving treatment.' Dr Stebbing added: 'It's a question of giving out the right amount of information at the right time. Patients only remember a portion of what you tell them. The message needs reinforcement from time to time.' One patient who has benefited from her doctor's slow and steady approach is Madam Lim Meng Choo. The 60-year-old executive secretary who was diagnosed with Stage 4 colon cancer in June said: 'My doctor was very forthcoming and told me what should be done for my case. He laid out my treatment options but the decision lay with me.' [email protected] Copyright © 2007 Singapore Press Holdings. All rights reserved. Privacy Statement & Condition of Access
S
M
T
W
T
F
S
04 05 06 07 08 09 10 11 12 13 14 15 16 17
Take Our Poll Site Map FAQ About Us RSS News Alert STI Widgets Newslink Best viewed at 1152x864 resolution with IE Copyright © 2008 Singapore Press Holdings 198402868E | Privacy Statement |
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