[Speaker Unknown] the pronouncement cancer often brings blind terror into the mind of laymen. The physician should not be helpless in this situation fashion has helped consist merely of a few sympathetic protective or truthfully spoken weren't followed by Marcos is with guns the practitioner must have knowledge to help in diagnosis and treatment to the stage when care is possible moreover he must also have courage in carrying out treatment even when they fail and a proper Chris are very attitude in managing incurable cancer what is the proper person varying attitude and approach to begin with should the cancer patient be told he has cancer I am sure that all practitioners in good conscience have pondered this question there is no hard and fast rule which can be applied here many variables influence the decision including the type of cancer case as well as the type of patient another individual circumstances as another medical problems success depends in large part on the continent care and detailed consideration with which the approach is implied certain types of cancer cases lend themselves more simply and successfully than others to the so called completely truthful attitude a position to pay these include the less incapacitated and easily curable cancer in which the disease and treatment are not often associated with misery and death basal cell cancer of the skin is a good example of this cancer inside too and borderline cancers are rising in pre cancerous lesions fit this category also included here of those cancers whose natural history indicates very slow growth and localization without spread for many years since the factual picture in these cases points to a relatively good prognosis it is possible to transfer the patient and optimistic point of view even when he is confronted with the true nature of his disease but the facts must be adequately presented and with understanding of the weak spots and patients pattern of the years and wistful escape a little knowledge can be a dangerous thing and even the faintest shadow of misery and death however remote they become a sort of doubt Maclean's to play the patient's peace of mind most cancers do not fit the above category at the other extreme there are many cancers which killed brutally if not quickly pendant which at present there is only a limited low cure rate included here are cancers of long he softened his stomach and pancreas in which the cure rate may be under ten percent and the disease associated with severe incapacitated symptoms should the truth the whole truth and nothing but the truth prevail here including details of prognosis as well as diagnosis since there is much to be said on both sides of us examine some of the fundamental consideration to begin with is the truth absolutely necessary I do not believe it is nor do I believe has the traditional medicines and dedicated to sharing every detail of knowledge with the public especially morbid and miserable facts the pronouncement of death has not been made by the doctor to the patient in all fatal diseases nor is it necessary to tell the patient the entire truth in order to Institute treatment of a radical nature this can be accomplished if the patient has confidence in his position such confidence and trust are constantly in pain by the physician was patient believes in his competence and sincere interest a letter to the patient refuse adequate and proper treatment that may be necessary to tell him the diagnosis it may also be necessary to tell him when there is no available responsible member of the family to relieve the patient's burden of publications such as business and family affairs Wales center usually a proper approach to suitable members of the family will greatly facilitate all these matters no patience remaining live can best be rearranged to fit his work to his strength to avoid premature hospitalization and to help improve his mower I'll few other activities this can only be accomplished if the family is given given sufficient knowledge insight and understanding of the disease certainly not an easy task but well worth it several studies have been done which purport to show that many cancer patients know they have their disease undoubtedly there are some who do know particularly because of what they have been told as well as their own high degree of technical knowledge however most patients are merely suspicious that they have cancer such suspicion has entirely different implications for the very essence of hope in living frequently lies in the narrow realm between suspicion and the factual realization of the misery and death that surrounds and awaits us and even the best and farmed may finally be full because of this internal need for hope however we may stated desire to know the truth and even have sufficient intellectual curiosity to seek it out we are not always able to cope with it the personality of the patient is background in education and beliefs his age and faith all must be considered by the physician in determining the proper attitude and approach some of us I want to be martyrs are still acts or SP acquiescence to fate is sometimes easier with advanced age and the man who tells us all I'll reach the problems of life and death in somewhat different fashion and the urbane city to Allah consistency of approach is essential to all physicians as well as family and others in attendance if one decides to tell the patient the true facts this should not be done recklessly a quick or casual pronouncement may be disastrous the patient may even seek suicide frequently the help of a psychotic this may be of value in reconciling the patient to his disease or death as well as the help of a minister of faith if one decides that it is better to share the burden with the family and spare the patient then it is necessary to pay considerable attention to each new development in the patient's course and present to him a satisfactory explanation of progress the sector the pace and the easier this may be calm with proper management the control of fever and infection the diminution of pain for the return of appetite all bring new hope the spoken word is only part of the proper considered approach to the difficult cancer case it is not enough to tell the patient he is getting better he must be made to feel it there is much to be gained by avoiding premature hospitalization and segregation of the patient and terminal care institutions constant symptomatic care on an ambulatory basis our home care is often adequate until the very last stages the use of anti pain drugs may become necessary but should not be indiscriminate are instituted too early it is a great temptation to pacify the patient his family and one's conscience by giving narcotics especially when the patient is considered incurable but the attendant complications may produce more difficulties than the disease itself courage in resisting the Hans lot of the patient in the family even in the middle of the night may be necessary to take advantage of any period of grace one cannot always accurately predict the time of death even unknown bad cases and then maybe a tendency to label the patient as hopeless to assume in our clinic the great majority of patients are treated on a relatively under the current basis are in the care of their families without the use of major narcotics until death is imminent the salvaging of the patients last few months of life through an active and useful existence is a great satisfaction to family and physician in summary it to be stated that the proper approach to the difficult cancer case to be one of courage and perseverance the decision as to whether or not to discuss the true nature of his disease with the patient should depend on complete understanding of the particular cancer problem as well as the patients personality and other individual circumstances one should avoid the easy way of a casual attitude early in our hostess and premature terminal care segregation proper ambulatory our home symptomatic care with the cooperation of the family and the attempt to maintain an active and useful existence with a patient will make the best of the worst of cancer