March Madness comes around once a year, bringing a collective standstill to office productivity as we are glued to our televisions and computers. College basketball teams battle over the course of the year with the hope of getting the coveted invite to the tournament that determines the national champion. After the season ends, the teams have to patiently wait on selection Sunday as a committee determines their fate based on their performance over the season. They wait patiently to see if their team will be selected to play another day and continue their journey to the championship.
Patients with cancer receiving treatment also battle each day with courage and dignity. After some time, they also have to anxiously wait to see if they are making progress in defeating their cancer. Patients have always reflected to me how difficult the pre- and post-scanning time can be. Today I would like to reflect on ways we can better address this fear to help our patients in the future.
As our patients embark on their brave journey battling cancer, they need objective measures to document if their treatment is working or not. Sometimes labs are drawn through their veins to help answer that question. Other times, patients are sent through multiple machines where their tumors are archived, photographed, and compared to distinguish subtle differences before and after treatment. These results are often sent to their ordering oncologist. Once the transfer of these results occurs from the computer chart, radiologist, or pathologist, the responsibility of delivering those results lies in the oncologist’s hands. The best way to share these data with the patient remains elusive. We can never go wrong by trying to put ourselves in their shoes and ask ourselves, “How would I want to hear this information?” I have learned from my patients how to deliver that news.
To be a successful oncologist, one has to learn to adapt to their individual patients. Each patient comes in with a different framework for how they would like to be involved in their care and how they would like the results of their diagnostic tests presented to them. Often, once the patient is scheduled for the scan, their internal clock starts ticking and their mind starts racing. Fear of the unknown can cause harmful effects to patients—some can’t sleep or function, and may even need medication to manage their anxiety.
I feel this is where we as oncologists can step in and address these emotions head on. Remaining oblivious to our patients’ anxiety will only cause future harm. Ask them directly before the scan is scheduled, “How are you feeling emotionally about the upcoming scan?” Get a sense of their fears and their coping strategies and what they will do to stay grounded before the scan. Acknowledging their fears and having an open discussion will prepare you for how to address what comes after the scan.
One of my first patients taught me that even when a scan shows positive results, we fail our patients if we don’t communicate upfront how we will deliver that news. I got the wonderful news regarding this patient’s scan, and waited until her visit one week later to share this with her. As she walked in, she was upset, and I realized that even when I said no news is good news before the scan, she need to hear the results from me in person to believe them. Trying to do better for another patient, I called her with her complete response on her CT scan, only to realize when she picked up the phone her son said she almost fainted, since when a doctor calls, “It can only be bad news.” These are clear examples where innocent missteps based on my preconceived notions led to me not honoring my patients’ wishes, leading to unnecessary anxiety for them.
We may never be able to completely eliminate anxiety and stress before and after scans, yet we can definitely make a difference by confronting scanxiety upfront. During every new visit, I make an effort to ask the patient how they want to be notified about their results. I explain that results are relayed to me at different times of the day through different methods. I stress how important it is for me to relay these results to them as quickly as possible; yet I need to know the method that they would prefer to learn this information. Taking a couple of minutes to have this conversation can spare you and your patient a lot of future stress and angst when it comes to results. The answers patients give me about their communication preferences remain varied, so I feel that giving them that peace of mind is truly invaluable. Try to keep your options simple regarding the method to communicate, i.e. phone call, email, inbox message in patient chart, or only in person. Take the time to document their preference in the chart and be consistent in how you communicate with your patient, which will help build the relationship between you.
As the NCAA basketball tournament unfolds, there will be tears of joy and tears of sadness. Brackets will be busted and an eventual winner will be crowned, with young men celebrating with tradition of cutting down the nets. For patients actively engaged in the game against cancer, there will also be defeats and tears. As an oncologist, I am encouraged that I am seeing fewer defeats and more successes with every new cancer drug approved and given to my patients. A patient enters every scan with hope that the promising treatments have been successful in controlling and defeating their disease. I commend doctors who have upfront conversations with their patients about how to deliver the results of those scans. I also encourage patients not to be afraid to tell their doctors how they would like to be notified of their results. Having this dialogue will only strengthen the bond between patient and doctor and given us the best chance to help them win against cancer.