In your oncology practice, how often do you use or hear the term “cure” to describe a patient’s status after successful treatment for cancer? After the 5-year mark with no recurrence? After the 10-year mark? Ever? Oncology specialists at Dana-Farber Cancer Institute were surveyed to find out how and when this term is used in the patient setting.
The results published in the July 2013 issue of Journal of Oncology Practice (JOP), revealed that of the 117 respondents who completed the survey, 81% were hesitant to tell a patient that they are cured, and 63% would never use the term. From the patient perspective, oncologists indicated that only 34% of patients actually ask if they are cured.
So, does this hesitancy change for clinicians who see patients for follow-up? According to the study, “for 20-year survivors of testicular cancer, large-cell lymphoma, and estrogen receptor [ER]–positive breast cancer, 84%, 76%, and 48% of clinicians, respectively, believed that the patients were cured, and 35%, 43%, and 56% recommended annual oncology follow-up of the patients.”1 The percentage for ER-positive breast cancer drops perhaps because of the risk of late recurrence for that cancer type, but in general, the study revealed that the longer the patient is in remission for a particular disease, the more likely the clinician is to believe they are cured.1
“Remission” versus “Cure”
The study highlights some of the differences in how other diseases are described. Diabetes, for example, is never cured; it is managed to keep the patient in optimal health while the disease is ever-present. Cancer, depending on the stage and success of treatment, may fall into this category—not curable, but manageable. The term “remission” is used when tumors have responded to treatment and are no longer detectable on tests, according to the American Cancer Society (ACS).2
According to the JOP article, the implications of not using the word cure are also significant. “Being in remission, rather than cured, may emphasize the importance of surveillance for cancer recurrence and result in less focus on the other tasks of cancer survivorship care, including screening for late and long-term effects and second or secondary cancers, time and effort spent on secondary prevention, and treatment of comorbidities, all of which become more relevant with increasing age.”1
Seasons of Survival
A pediatrician, who has experienced cancer as a patient, describes the “seasons of survival” for the post-diagnosis and treatment phase and post-treatment phase in a New England of Journal of Medicine article. In “Seasons of Survival: Reflections of a Physician with Cancer”, Fitzhugh Mullan, MD, described his feelings about the word cure when he first learned of his diagnosis. “Cure. The word itself became magic for me, a time when everything would be alright again, when the shadow on my life would be gone, when normal life would resume.”3
Dr. Mullan suggested the term “permanent survival” as an equivalent to the word cure to describe the season of survival after treatment has ended and the cancer is nowhere present on tests, but the patient is still dealing with the late effects of treatment that may have adversely affected the patient’s health and well-being.
It is clear from the survey and the poignant reflection of a physician who was successfully treated for cancer that the terms both patients and physicians use are important, and heavy with meaning. One must choose carefully and be sure that both the medical team and the patients are working from the same definitions and understanding, particularly when discussing the post-treatment phase.
1. Miller K, Abraham JH, Rhodes L, et al. Use of the word “cure” in oncology. J Oncol Pract. 2013:e136-e140.
2. American Cancer Society. When cancer doesn’t go away. http://www.cancer.org/treatment/survivorshipduringandaftertreatment/when-cancer-doesnt-go-away. Last accessed October 8, 2013.
3. Mullan F. Seasons of Survival: Reflections of a Physician with Cancer. N Eng J Med. 1985;313(4):270-3.