Should Cancer Patients Be Told Their Diagnosis?

The right of cancer patients to know their condition has long been a dilemma for many families. Relatives generally believe that if the truth is told, the patient will be unable to bear it. It is true that when patients learn they have cancer, they suffer a severe psychological blow. But compared with concealing the illness, that blow causes far fewer side effects.

Patients have the right to know that their life is threatened. Knowing the truth has many benefits. The last and strongest guardian of a patient's life is the patient himself; when it comes to safeguarding his own life, no relative can take his place. The negative emotions that arise after disclosure can be largely diluted by renewed hope after professional psychological counseling.

The great majority of patients, once they know their condition, cooperate much better with treatment. They conscientiously follow medical orders, deeply reflect on why they fell ill, change unhealthy lifestyle and mental habits, and seriously study anti-cancer knowledge. All of this is very helpful to recovery.

While concealing the illness, some families also make many inappropriate arrangements. Some of these may directly, even fatally, harm the patient's health. Especially in a country where the idea that cancer is a controllable chronic disease has not yet taken hold, many families, upon learning the diagnosis, do not strictly follow medical advice; they decide on their own that the most important thing is to let the patient eat, drink, and be merry. Thus one commonly sees families hiding the diagnosis while dragging the patient on strenuous tours (even in the perioperative period) and on sprees of eating and drinking—all of which directly worsen the condition.

From my experience with patients, once patients know their own condition and have gone through a period of psychological struggle, the great majority choose to forgo these frantic indulgences in order to hold onto life a while longer. Families really cannot make the final decision for the patient. When a person's life is about to end, each has wishes he most wants fulfilled; if the family conceals the truth, the patient loses the chance to choose how to spend his remaining days.

In choosing a treatment plan, the patient has the right to decide for himself, whether the decision is right or wrong. Many families assume the patient will panic; in fact, most relatives are the patient's spouse or children, and in life experience they may be no better equipped than the patient himself; the patient's own decision may be more reasonable. Moreover, when it comes to the quality of outcome, only the person being treated has the truest say; even test instruments are not necessarily more objective than the patient's own sensations. Some patients, after treatment, have excellent numbers on the instruments yet die rapidly because their bodies have collapsed. Outcome can only be judged by the patient, from his own feelings.

In my view, what relatives most need to do is not conceal the diagnosis but provide psychological support: to console the patient after disclosure, to care for him, and to introduce as much positive information as possible. Most patients are not as fragile as relatives imagine; once informed, after initial panic they become calm. Some patients were rigid and inflexible before knowing but became rounded and gentle afterward; disclosure is not only a bad thing.

When I see patients and give medical advice, I usually prefer to explain directly to the patient rather than to the family, because relatives may filter out quite important parts of the instructions, which harms treatment and recovery. I also try to persuade families not to conceal the diagnosis, though such persuasion often fails.

As the saying goes, paper cannot wrap fire; in the end no one can conceal the patient's condition. The earlier the patient knows, the earlier he can arrange the rest of his life. After being consoled by relatives, friends, and doctors, most patients can face this crisis positively. Put yourself in their place: which of us has not, in ordinary times, imagined our own death? Everyone born must die; when the Grim Reaper draws near, it is not necessarily true that it kills on the spot.

Treating cancer requires not only conventional therapy but also psychological intervention. As doctors we should provide the patient with appropriate counseling and support rather than comply with the family's demand to hide the truth. Concealment is simple and saves trouble, and in the end one is less likely to be blamed, but it does the medical cause no good. Treatment requires close cooperation; if the patient does not know he has serious cancer, he often lets down his guard after superficial recovery and refuses subsequent treatment, missing the chance to be saved.

In short, no one has the right to strip cancer patients of their right to know. Concealing the illness looks like protecting the patient, but in fact it harms him greatly.