For Cancer Patients, Empathy Goes a Long Way

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January 8, 2008

For Cancer Patients, Empathy Goes a Long Way

By DENISE GRADY

Four years ago, my sister found out she had two types of cancer at the same

time. It was like being hit by lightning - twice.

She needed chemotherapy and radiation, a huge operation, more chemotherapy and

then a smaller operation. All in all, the treatment took about a year. Thin to

begin with, she lost 30 pounds. The chemo caused cracks in her fingers, dry

eyes, anemia and mouth sores so painful they kept her awake at night. A lot of

her hair fell out. The radiation burned her skin. Bony, red-eyed, weak and

frightfully pale, she tied scarves on her head, plastered her fingers with

Band-Aids and somehow toughed it out.

She saw two doctors quite often. The radiation oncologist would sling her arm

around my sister's frail shoulders and walk her down the corridor as if they

were old friends. The medical oncologist kept a close watch on the side effects,

suggested remedies, reminded my sister she had good odds of beating the cancer

and reassured her that the hair would grow back. (It did.)

People in my family aren't huggy-kissy types, but my sister greatly appreciated

the warmth and concern of those two women. She trusted them completely, and

their advice. Now healthy, she says their compassion played a big part in

helping her get through a difficult and frightening time.

Research supports the idea that a few kind words from an oncologist - what used

to be called bedside manner - can go a long way toward helping people with

cancer understand their treatment, stick with it, cope better and maybe even

fare better medically.

" It is absolutely the role of the oncologist " to provide a bit of emotional

support, said Dr. A. Tulsky, director of the Center for Palliative Care at

Duke University Medical Center.

But in a study published last month in the Journal of Clinical Oncology, Dr.

Tulsky and other researchers found that doctors and patients weren't

communicating all that well about emotions.

The researchers recorded 398 conversations between 51 oncologists and 270

patients with advanced cancer. They listened for moments when patients expressed

negative emotions like fear, anger or sadness, and for the doctors' replies.

A response like " I can imagine how scary this must be for you " was considered

empathetic - a " continuer " that would allow patients to keep expressing their

emotions. But a comment like " Give us time; we are getting there " was labeled a

" terminator " that could shut the patient down.

The team found that doctors used continuers only 22 percent of the time. Male

doctors were worse at it than female ones: 48 percent of the men never used

continuers, as opposed to 20 percent of the women.

Surprisingly, Dr. Tulsky said, the patients didn't bring up emotions that often

- in only 37 percent of the conversations.

" That's extraordinary, " he said. " These are advanced cancer patients. "

The reason is not clear, but he said the patients might not expect emotional

support from doctors. Feelings were most often discussed when both doctor and

patient were female, and younger doctors who considered themselves more

" socioemotional " than " technical " gave empathetic replies more often.

One doctor who was especially good with patients, and who often consulted on

very serious cases, opened discussions with new patients by saying, " Tell me

what you understand about your illness, " Dr. Tulsky said. And when patients

wept, this doctor would pause and wait until they were ready to continue the

discussion.

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