How Long Do We Have?

A cancer patient asks, “How much longer do I have?”

How do you respond?

A mentor of mine always started with, “Well, I don’t have a crystal ball, but…” and then proceeded to gently predict the future. He always provided some hope, yet relentless cancer progression at the end of life is real. (We later gave him a crystal ball.)

In their article Prognostic Disclosure to Patients With Cancer Near the End of Life (Ann Intern Med 2001; 134:1096), Lamont and Christakis found that only about one-third of physicians will provide accurate survival predictions to hospice patients dying of cancer. About one-third will provide an overly optimistic answer. About 20% of physicians would never provide any prediction. A few physicians said that they would be overly pessimistic. As a profession, we were criticized in the lay press for not being honest with our most vulnerable patients.

The paper also showed that we are lousy at making predictions. The physicians honestly believed that the patients would live a median of 75 days. The actual survival was only 26 days.

We all avoid tough situations. Still, the relationships that develop between the patient, the family, and the care providers can be the most rewarding part of a cancer practice. Good physicians seek to deal positively with the ambiguity that these situations create. I learned many years ago that “The physician’s prime task is to just be present.” The relationship shapes the session. When patients ask me now much longer they have, I try to answer, “How much longer do we have?”

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.