For Cancer Patients, Empathy Goes a Long Way

By DENISE GRADY
Four years ago, my sister found out she had two types of cancer at the same time. It was like being hit by lightning — twice.
She needed chemotherapy and radiation, a huge operation, more chemotherapy and then a smaller operation. All in all, the treatment took about a year. Thin to begin with, she lost 30 pounds. The chemo caused cracks in her fingers, dry eyes, anemia and mouth sores so painful they kept her awake at night. A lot of her hair fell out. The radiation burned her skin. Bony, red-eyed, weak and frightfully pale, she tied scarves on her head, plastered her fingers with Band-Aids and somehow toughed it out.
She saw two doctors quite often. The radiation oncologist would sling her arm around my sister’s frail shoulders and walk her down the corridor as if they were old friends. The medical oncologist kept a close watch on the side effects, suggested remedies, reminded my sister she had good odds of beating the cancer and reassured her that the hair would grow back. (It did.)
People in my family aren’t huggy-kissy types, but my sister greatly appreciated the warmth and concern of those two women. She trusted them completely, and their advice. Now healthy, she says their compassion played a big part in helping her get through a difficult and frightening time.
Research supports the idea that a few kind words from an oncologist — what used to be called bedside manner — can go a long way toward helping people with cancer understand their treatment, stick with it, cope better and maybe even fare better medically.
“It is absolutely the role of the oncologist” to provide a bit of emotional support, said Dr. James A. Tulsky, director of the Center for Palliative Care at Duke University Medical Center.
But in a study published last month in the Journal of Clinical Oncology, Dr. Tulsky and other researchers found that doctors and patients weren’t communicating all that well about emotions.
The researchers recorded 398 conversations between 51 oncologists and 270 patients with advanced cancer. They listened for moments when patients expressed negative emotions like fear, anger or sadness, and for the doctors’ replies.
A response like “I can imagine how scary this must be for you” was considered empathetic — a “continuer” that would allow patients to keep expressing their emotions. But a comment like “Give us time; we are getting there” was labeled a “terminator” that could shut the patient down.
The team found that doctors used continuers only 22 percent of the time. Male doctors were worse at it than female ones: 48 percent of the men never used continuers, as opposed to 20 percent of the women.
Surprisingly, Dr. Tulsky said, the patients didn’t bring up emotions that often — in only 37 percent of the conversations.
“That’s extraordinary,” he said. “These are advanced cancer patients.”
The reason is not clear, but he said the patients might not expect emotional support from doctors. Feelings were most often discussed when both doctor and patient were female, and younger doctors who considered themselves more “socioemotional” than “technical” gave empathetic replies more often.
One doctor who was especially good with patients, and who often consulted on very serious cases, opened discussions with new patients by saying, “Tell me what you understand about your illness,” Dr. Tulsky said. And when patients wept, this doctor would pause and wait until they were ready to continue the discussion.
By contrast, with other doctors, Dr. Tulsky said, “There were a number of times when patients brought up emotional content and it went right by the doctors.”
For instance, a patient would say, “I’m scared,” and the doctor would go off on a “scientific riff” about the disease, Dr. Tulsky said, adding, “We saw that a lot.”
The doctors don’t lack empathy, he said. They just have trouble expressing it.
“Oncologists care deeply for their patients,” said Kathryn I. Pollak, the first author of the study and a social psychologist at Duke. “It’s clear from listening to the tapes.”
Cancer patients and oncologists have unique, intense relationships, she said, because the patients are fighting for their lives.
Even so, oncologists sometimes miss signs of distress, particularly if those signs are indirect, she said. For example, a patient may ask how big the tumors are, and the doctor may answer in millimeters — when the patient really wants to know: “Is the cancer getting worse? Am I dying?”
The good news, she and Dr. Tulsky said, is that most doctors can be taught to respond in more helpful ways. Brief, empathetic responses will suffice, the researchers said; they are not recommending extensive counseling or endless dialogue.
Patients may benefit from some coaching, too. It’s perfectly reasonable, Dr. Tulsky said, to talk to an oncologist about sadness or fears about treatment, and to ask for help.
“You’re vulnerable when you express your emotions,” Dr. Pollak said. “But I would advise patients to be as direct as possible.”