Breaking bad news to cancer sufferers is more difficult during Christmas time but life carries on and if treatment is urgent doctors cannot wait until the celebrations are over.
“We are inclined to wait until after Christmas if the treatment can wait, like in some low grade lymphoma (manifested in a solid tumour) cases,” Alexander Gatt, consultant at the Department of Haematology and Oncology said.
“But, sometimes, we have no choice, especially if delaying it makes the condition worse. It’s more difficult to break the news at this time of year but we have to carry on. Safety comes first and we cannot let these emotional difficulties affect the treatment outcome,” Dr Gatt, who specialised seven years ago and has been a consultant for six, added.
When giving bad news at this time of year, Dr Gatt keeps in mind that, if treatment starts immediately, sufferers will be able to enjoy succeeding Christmases. “It is not the first time I’ve had to break bad news on Christmas Eve and Boxing Day but my satisfaction is to see the same people out of hospital in the next Christmas festivities.”
Breaking the news to a leukaemia or other blood disorder sufferer comes after the consultant forms a rapport built on trust with the patient. But no matter the relationship, it is always difficult.
“Giving bad news has a large impact on me but I take advantage of empathy. Empathy does not translate into pity but into understanding what they are going to go through. I put myself in their shoes to understand how to tackle the issues we face together with the patients and their relatives.
“I also need to make sure they understand what is going on, that we’ll try our best and that, for me, they are not ‘another patient with cancer’.”
Dr Gatt believes that some sufferers, who have been undergoing numerous diagnostic tests, are relieved when the doctors pinpoint a particular disorder and they are ready to fight. Others are happy to leave it up to the doctors and trust they will do their best but there are some who would rather not be told anything.
Some sufferers are in a continuous state of denial despite going through biopsy and tests. On the other hand, relatives are in a calmer state of mind and are more realistic.
By the time sufferers are referred to the consultant by their general practitioner and other specialists or surgeons that carry out the diagnostic biopsy, both the patient and the relatives would have started to adjust to the notion that they could be diagnosed with some condition.
But despite a high survival rate in haematology cases – including lymphoma, leukaemia and other blood disorders – telling someone they are a sufferer is like “giving a death sentence”. This is the first barrier that the doctors have to deal with.
However, Dr Gatt explained that the easy access to internet helped prepare sufferers for what they could expect.
“I try to focus on the positive issues – possible treatment and survival rate – even though I inform them that the following six months will be tough.
“When you know there is no remedy – which happens in the rarest of cases – it feels like a tragedy, so I break the news slowly by going through the history and explaining that we have exhausted all means. Sometimes people need to know...
“At times, I do keep thinking about my patients but by time you learn where to draw a line and that there is a whole medical team behind the treatment. If the sufferer does not manage to reach me, there is always someone on call,” he adds.
The Haematology and Oncology Department holds multidisciplinary meetings on taking decisions to break the news and, for the first time this year, the Health Department held a course about breaking bad news. There are plans to add this training to the academic curriculum.
Cancer diagnosis is on the rise because of an ageing population and some die of other causes rather than cancer itself.
As the elderly in Malta often argued that they have lived their lives, it made it difficult for doctors to convince some of them that there was an effective therapy for them too. Dr Gatt added there was a need of an infrastructure catering for the elderly that went beyond respite homes. This could include specialist oncology nurses that took treatment to the sufferer’s home, alleviating the social burden and shifting it towards the community.