UICC World Cancer Congress 2006

It is a paradox that in this age of limitless information and increased communication by electronic networks the constant complaint of all patients is the lack of adequate communication. Indeed we strayed far from the principle that the communication between a doctor and his patient was not only a secret even officially recognized in a court of law but close to a sacred bond to the oath of Hippocratus. A nice word in French is ‘le colloque singulier' creating a bond between the doctor and the patient that gave him his trust. This bond fortunately still exists in private praxis where the physician evaluates the physical problems of the patient but simultaneously tries to feel the psychological and emotional needs of his patient. The amazing development of our medical services into a high tech, computer managed establishment where most health personnel from surgeon to laboratory technician perform a specific task regulated by health outcomes submitted to laws of efficacy vs. costs leaves no space for this type of communication. Driven by the complexity of the medical field we find organized subdivisions that function independently from the overall organization and leave the patient perplexed if his condition needs the expert advice of different specialties. Cancer care should be considered as a special case for communication. There is consensus that multiprofessional care is the best basis for expert care but here the patient in contrast to a broken arm or diabetes remains under the spell of the great taboo that his life is at stake creating irrational panic and a need for emotional security. A literature search documents easily that despite the presence of or maybe because of the presence of huge mountains of information as never seen before the first need of the patient to feel guided, have trust and keeps hope remains a problem. This type of communication is not heavy in the training and continuing education programs and physicians stay away from getting involved. All top organizations preach the communication skills as a fundamental to improve supportive and palliative care of cancer patients. However in reality we usually find a panicked patient and a doctor without time (figure 1). Still we find in the myriad of uncertainties a transparent scheme on defining the situation, walk the patient through his emotional stage, give tailored advice and holistic care in relation to the clinical situation a road to shared decision making. The opening confrontation to the clinic/disease facility is crucial and nurses, technicians and related personnel play a key role in the general atmosphere of benefit to the patient and the health personnel alike. Last but not least we feel that the existence of patient groups of different diseases can be a lifeline of support for patient and families in distress. Non soleus one does not have cancer alone and a common sense algorithm will solve most of the problems.