This document discusses ways to improve communication between cancer patients and their oncologists. It notes that while oncologist training in communication has increased, there is still room for improvement. A common issue is "collusion", where patients hesitate to bring up difficult topics and doctors don't ask, resulting in important conversations not occurring. The document provides examples of questions patients may want to ask their oncologists about various topics like prognosis, diet, exercise, medical care, travel, insurance, and sex during/after treatment. It emphasizes that oncologists can't be aware of all patient concerns, so patients should take the initiative to ask questions about integrating treatment into their daily lives.

1. What Your Oncologist Expects
You to Ask
Dana Nolan, MS LMHC
Licensed Mental Health Counselor

2. Patient-Oncologist Communication
 Physicians receive little training in communication
other than medical interviewing & history taking in
medical school.
 Numerous studies indicate doctor-patient
communication is subpar and leads to
psychological and existential suffering in patients
(Back, 2005).
 In the last decade, there has been an increase in
training oncologists during residency about
discussing difficult issues with patients, but there
is still room for improvement
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3. Collusion
 Collusion (withholding information) is a common
communication problem between cancer patient and
physician.
 A patient may hesitate to bring up a difficult topic,
and the physician doesn’t ask.
 Difficult topics include prognosis and safety of having
sex during treatment.
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4. Why Does Collusion Happen?
Assumptions:
 Patient assumes oncologist will bring up an issue if it is
important.
 Doctor assumes patient wants to know something about a
potentially touchy subject the patient will bring it up.
Result:
 Conversations important to the patient will not happen.
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5. Prognosis
 Some patients do not want to know their physician’s estimate of
how long they will live with or without certain treatments.
 They say knowing takes away their hope.
 Most oncologists these days do not offer prognosis information
unless the patient specifically asks for it.
 Caregivers may want to know, but the patient doesn’t or vice
versa.
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6. What to Eat or Drink
 Should I be eating organic? Will eating fried
foods make my nausea worse?
 Can I eat sushi, red meat or cheese?
 Should I avoid sugar? Should I become a
vegetarian?
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Physicians are not trained specifically in dietary and nutrition
issues and routinely refer patients to registered dietitians who
specialize in oncology nutrition.

7. Physical Activity
 Patients may wonder if it is a good idea
to continue working out at the gym,
attend their exercise class or resume
their normal exercise routine.
 Should I be exercising more because it
will help with fatigue?
 Should I be resting more to help my
body fight the cancer?
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8. Routine Medical Care
 Is it safe to get my annual flu shot
while I am on chemo?
 Should I get a mammogram or
yearly chest X-ray?
 Can I take my daily vitamins or
supplements I have taken for years?
 Will my chemo affect my PSA count?
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9. Travel & Family
 Can I fly, take a train or bus to
visit my family while I’m in
treatment?
 Am I safe to be around babies
when I am getting chemo? Can
babies or toddlers potentially
give me their germs?
 Is it safe to eat out at
restaurants?
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10. Insurance & Money Concerns
 Can I get my scans done a
few weeks early? I want to
take advantage of having met
my yearly deductible.
 I can’t afford to travel for a
second opinion or clinical
trial.
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11. Sex During and After Treatment
 Is it safe to have sex during chemo or 4 weeks after
surgery?
 Will chemo affect my libido? Will the treatment affect
my ability to have intercourse?
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12. Improving Communication
There are many reasons your oncologist may not bring up some
of these issues:
 They may not be aware a particular issue, such as insurance
coverage, worries you.
 They may have some discomfort at bringing it up, such as
discussing sex, with patients because of negative past
experiences with other patients.
 They know not all patients want the same depth of
information
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13. Your Role
 Your oncologist can’t know everything about your fears,
financial or insurance situation, family priorities, hobbies, sex
life, etc.
 Their goal is to ensure you understand your disease,
treatment plan and potential side effects.
 Your role is to take that information, integrate it into your
life and family, and ask questions about what you can and
can’t do with your doctor.
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14. Your Role (cont.)
 You are not the first or last patient to ask your
oncologist or oncology nurse about travelling, sex or
prognosis, so keep that in mind if you’re worried or
anxious about asking questions.
 Ask for a longer appointment when you have lots of
questions.
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15. Sources
Back, A.L. et al. (2009, February 24).
Approaching Difficult Communication Tasks in
Oncology. Retrieved from
http://onlinelibrary.wiley.com/doi/10.3322/canjclin.
55.3.164/abstract
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16. Contact Information
1-800-615-2270
(800) 615-2270