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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 363

Author reply to Thomas et al., Konstantis and Chittem et al.


Department of Medical Oncology, Aster Malabar Institute of Medical Sciences, Kozhikode, Kerala, India

Date of Submission31-Mar-2020
Date of Decision01-Apr-2020
Date of Acceptance02-Apr-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Arun Chandrasekharan
Department of Medical Oncology, Aster Malabar Institute of Medical Sciences, Mini Bypass Road, Govindapuram, Kozhikode - 673 016, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CRST.CRST_104_20

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How to cite this article:
Chandrasekharan A. Author reply to Thomas et al., Konstantis and Chittem et al. Cancer Res Stat Treat 2020;3:363

How to cite this URL:
Chandrasekharan A. Author reply to Thomas et al., Konstantis and Chittem et al. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 16];3:363. Available from: http://www.crstonline.com/text.asp?2020/3/2/363/287196



Chittem et al.[1] expertly break down the Indian psyche regarding cancer communication and lay out a map to help navigate the stormy seas of “patient disclosure.” Studies have shown that hiding prognosis may definitely worsen the course of treatment. Thomas[2] and Konstantis[3] also recommend questioning the patients about their preferred extent of disclosure of prognosis.[4]

One aspect that could be considered a barrier to informed choice is the low health literacy that prevails in our country. Health literacy is defined as the extent to which individuals have the capacity to obtain, process, and understand basic health information and services required to make appropriate health decisions.[5] We have had several instances where the patients did not want to know about their prognosis, as it was difficult for them to comprehend despite simplifying things as much as possible. In such cases, a responsible family member was chosen by the patients for further decision-making and discussions.

In certain other circumstances, the relative/decision maker informs us that the patient is of a weak constitution and would not be able to handle a diagnosis of cancer. In such cases, we recommend psychiatric counseling prior to breaking the news to the patient.[6] However, even that carries a stigma, and I have had patients vehemently refuse an appointment with the psychiatrist, thinking that others would label him “mad.”

In a country like ours, where rampant misinformation and bizarre stigma permeate deep and where people even commit suicide based on the suspicion of having the Coronavirus disease,[7] or on being diagnosed with cancer,[8],[9] much more headway needs to be made before achieving complete “patient disclosure” among all our patients. The suggestions of Thomas, Chittem and Konstantis go a long way in accomplishing this, but to quote Frost, there are “miles to go before I sleep.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chittem M, Maya S. A twist in the tale: Alternate methods to communicate or are they great expectations? Cancer Res Stat Treat 2020;3:360-1.  Back to cited text no. 1
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2.
Thomas VM, Mathew A. Truth-telling: Apply the principle of beneficence. Cancer Res Stat Treat 2020;3:359-60.  Back to cited text no. 2
  [Full text]  
3.
Konstantis A. Breaking bad news and autonomy of cancer patients. Cancer Res Stat Treat 2020;3:362.  Back to cited text no. 3
  [Full text]  
4.
Chandrasekharan A. A tale of two patients. Cancer Res Stat Treat 2020;3:1-2.  Back to cited text no. 4
  [Full text]  
5.
Xia J, Wu P, Deng Q, Yan R, Yang R, Lv B, et al. Relationship between health literacy and quality of life among cancer survivors in China: A cross-sectional study. BMJ Open 2019;9:e028458.  Back to cited text no. 5
    
6.
Kar SK, Thakur M. Unmet mental health needs in cancer patients in India: What needs to be done? Cancer Res Stat Treat 2020;3:158-9.  Back to cited text no. 6
  [Full text]  
7.
Pavan P. COVID-19: Two Commit Suicide out of Fear. Bangalore Mirror; 2020. Available from: https://bangaloremirror.indiatimes.com/news/india/covid-19-two-commit-suicide-out-of-fear/articleshow/74866584.cms. [Last accessed on 2020 Mar 29].  Back to cited text no. 7
    
8.
Jagan SM, Abraham J, Mathew A. Mental health care as part of cancer care: A call for action. Cancer Res Stat Treat 2019;2:244-5  Back to cited text no. 8
    
9.
Bhat RS, Dighe MD. Mental health care as part of cancer care: A call for action, advocacy, and activism. Cancer Res Stat Treat 2020;3:159-60.  Back to cited text no. 9
  [Full text]  




 

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