Sunday, June 16, 2013

Singapore - 1 in 4 cancer patients unaware of illness: Study

SINGAPORE - About one in four cancer patients do not know they have cancer, and older patients are even less likely to be informed of their diagnoses. The burden appears to be borne by their family members instead, very few of whom would not be in the information loop.

Such findings suggest a strong family-centred approach in the care of cancer patients, noted a paper published in the Singapore Medical Journal last month.

This has implications for care, said Dover Park Hospice medical director Angel Lee, who was not involved in the study. She said advance care planning, which involves discussions about future medical decisions, is a "key pillar" in palliative care. It is important that patients understand their illness and treatment options.

In the study of 100 patients admitted to Assisi Hospice Home Care in 2004, 23 were not told that they had cancer, compared to just 2 per cent of family members who lived with or cared for the patients.

The study by Dr Kao Yung Hsiang and Associate Professor Cynthia Goh also found that those aged 70 years old and above were much more likely to be unaware of their diagnoses, especially if they were in frail health.

Prof Goh, a palliative care physician at the National Cancer Centre Singapore, said the findings continue to hold true.

A 2010 Dover Park Hospice survey found 25 per cent of patients admitted to the hospice were unaware of their diagnosis. Even more - half - were unaware of the prognosis.

Dr Kao suggested that in the traditional Singaporean family, older patients with less education usually allow younger and better-educated family members to make medical decisions on their behalf, pre-disposing them to non-disclosure.

"In the Asian context, that is commonly perceived as an act of filial piety," said Dr Kao, a former Singapore General Hospital registrar, now a fellow in a hospital in Melbourne.

Mr Roger Lim's family, for instance, chose not to tell their mother that she was diagnosed with terminal cancer and had only six months to live. "If she was younger and could fight the illness, we would have told her. But we understand her, and know that she would be unable to accept the reality of her condition," said Mr Lim, 48, the youngest of nine children.

But they are preparing her for her death. When she asked Mr Lim why she was feeling progressively weaker, he told her it was because she was 85, and added that death would be natural for someone her age.

The family is also making her final days comfortable, by letting her eat what she likes, visiting her daily, and asking if she has any last wishes.

But though families have good intentions and some patients truly do not want to know, they have a right to their own diagnoses, say doctors.

"Studies show most people would want to know what to expect in the future, be able to prepare for it and make their wishes known," said Dr Goh.

To encourage the practice of disclosure, doctors can advocate it to patients, said Dr Kao.

Melissa Pang

The Straits Times

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