There are no data on the proper approach to informing a patient of a cancer recurrence, but the same considerations listed above are important, including the assurance that things can always be done to help the patient. Failure to educate the patient on this conceptually important point by what is said and what is done can lead to unfulfilled expectations, alienation from the medical establishment, hostility, and noncompliance with therapy. When the treatment strategy changes to supportive care from care specifically directed to the cancer, as is usually the case as disease progression occurs, fear of abandonment by the physician commonly emerges. This fear can be an important source of worry for the terminally ill patient. It is very important for physicians to acknowledge the patient's fear of abandonment and to assure the patient that it will not happen.
Patients also fear loss of control and commonly fear dependency.
These are both real consequences of disease progression, but often the patient's fear is anticipatory. Efforts should be made to give the patient as much control in decision making as he or she wishes and to foster and support efforts that provide avenues to display independence. Cancer patients at high risk for poor adjustment can be identified at the initial visit. These facts are all part of a thorough history, and their presence should alert the physician to the possibility that a patient will need greater assistance in coping with cancer. Studies show that an effective, simple method for enhancing coping skills is to educate patients about the medical facts and treatment of their cancer.