Hope and incurable Cancer: does hope torment or does it help to cope?

A diagnosis of incurable and advanced cancer is often a massive shock to everyone.

Should we ask them to face reality , accept death and extinguish all hope.

Or should we be offering hope of living a bit longer with treatments while being honest with prognosis.

Hope can be tormenting to some.

Hope can be comforting to some.

What are you views?

Contribute your views at online rapid response @BMJ journal

Don’t torment me with hope. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3016 (Published 09 September 2020)Cite this as: BMJ 2020;370:m3016

In defence of Hope: https://www.bmj.com/content/370/bmj.m3016/rr-3

Is it worthwhile to be on constant vigilance for any symptoms which might indicate cancer has come back ?

Unfortunately no.

A Cancer charity advices to watch out for symptoms.

Constant Vigilance for cancer recurrence has its own downsides.

After successful cancer treatment, being on look out for symptoms constantly wrecks your quality of life for minimal benefit in most cases.

Many trials of intensive screening shown no benefit for early detection of secondary cancer. ( note- this is different from the ongoing debate about benefits of primary cancer detection with cancer screening programs such as Mammograms, PSA screening, bowel cancer screening).

Cancer patients are quite often aware of own body and pre-existing aches and pains.

The best thing is to act promptly if there are “any new and persistent symptoms” . For vast majority of cancer patients, there is no need to do a frequent check list of possible symptoms, on a daily or weekly interval.

Do NOT be on constant vigilance for all possible cancer symptoms unless you have been specifically advised to do so by your oncology team.

Eternal Vigilance for months and years can wreck your quality of life.

Think Positive. Nothing is lost when you maintain hope.


BBC news . https://www.bbc.co.uk/news/health-49999404

‘Unacceptable’ delays in diagnosing secondary breast cancer

The standard disclaimer is very relevant to this blog.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only. See your own doctor to discuss concerns and options relevant for you.

Plain English Medical Letters to Patients

Writing letters to patients in plain English without medical jargon is a gift that only a few doctors possess.

Personalising complex medical terminology in a letter dictated over a few minutes is NOT an inherent skill possessed by many doctors including those who are native English speakers.

Dictating Plain English medical letters would take considerable time and effort – particularly if letters are going to succinctly summarise everything from a medical consultation.

In UK, with regards to Cancer, we are lucky to have cancer charities who do a good job of providing information in plain English ( E.g Cancer Research UK, Macmillan Cancer Support, Prostate Cancer UK).

Cancer Patients in UK also have the support of Cancer Nurse Specialists ( CNS ) who do a fantastic job of guiding patients through their cancer journey and clarify all medical jargon to patients.

Other specialities might not have the resources that are available to cancer patients. But, on the whole, Clinic Time slots are precious. Many UK specialists have long waiting lists.

So if further time and effort is to be expended in busy clinics for dictating plain English Letters – in addition to the usual Medical letters to GP – good clinical evidence is needed to demonstrate that separate plain English letters do benefit patients in a meaningful way.

Please do read the BMJ article and put forward your views in the rapid response section.

Access the article at: http://bmj.com/cgi/content/full/bmj.m949

Toll-free link:


The views expressed here are my personal views and do not represent the views of any other professional organisation I am associated with…

How to communicate that the disease is mild even though symptoms are disabling?

women s white long sleeved top

Beth McHugh makes a strong argument for doctors “not to explicitly discuss disease severity scale”.


(1) A valid informed consent would then become difficult

(2) Not discussing severity, is not a practical option for patients with certain illness.

My BMJ eLetter on this topic…

Risk categorisation will continue to be the norm in future as genomic data leads to personalised medicine.

England’s 100 000 Genomes Project