Key Points
- While doctors help cure people, they are continuously the bearer of bad news.
- Insight asks what it’s like to give people a terminal prognosis.
What would you do if you were told you had limited time to live? And what happens if you outlive your prognosis? Insight talks to cancer patients about beating the odds, and doctors on giving the bad news. Watch, Tuesday October 4 at 8:30pm on SBS or on On Demand.
For more than 20 years, medical oncologist and author Dr Ranjana Srivastava has regularly delivered cancer prognoses and said it doesn’t get any easier.
“I think there’s not a day that goes by when I go to work, that I don't deliver bad news,” she said.
Giving a prognosis, or predicting how much time a patient has left, is more an art than science, according to Dr Srivastava, who has been awarded the Order of Australia Medal for her contribution to the field of doctor-patient communication.
“The typical questions patients asked me is ‘what stage is my cancer?’ And then, ‘how long do I have?’”
Medical oncologist and author Dr Ranjana Srivastava
This year, more than 162,000 new cases of cancer will be diagnosed in Australia, according to the Australian Institute of Health and Welfare (AIHW).
You will get prognosticating wrong, in many instances, and hopefully happily so.Dr Ranjana Srivastava
Dr Srivastava said “the difficulty with prognosticating, especially initially, when you have just met the patient, is trying to put all those pieces together. And to be honest, those pieces only get put together in the trajectory of cancer treatment.
“But also … the human body is ultimately very humbling. And so, you will get prognosticating wrong, in many instances, and hopefully happily so.”
Combining all cancers, statistics from AIHW show there’s a 70 per cent chance of relative survival five years from diagnosis.
The survival rate for various cancers has also increased by 20 per cent in the past three decades thanks to new medical technologies and treatments, according to The Australian Cancer Research Foundation.
Shelley at her birthday.
Consoling my doctor
When Shelley Argent visited her doctor for a routine check-up and blood test last March, he told her she had three months to live.
The then 71-year-old, didn’t expect the appointment would result in such a drastic diagnosis.
“I just thought to myself, ‘there’s something wrong,’” Shelley told Insight’s Kumi Taguchi.
He was only a young doctor and there he is telling this woman she's going to dieShelley Argent
“The doctor had to tell me that I had acute myeloid leukemia (AML) and that I had about three months to live.
“He was only a young doctor and there he is telling this woman she's going to die.”
Shelley said while her doctor delivered the news in a ‘matter of fact’ manner, she could tell he was confronted by the experience so she ended up consoling him.
Shelley on her birthday.
“I figured I had lived my life. I had made a change in the world. I've been everywhere, done everything I wanted, and I felt there was no more reason for me to be here. And so, I was comfortable with that,” Shelley said.
I have always believed that if I knew I was done, I would want to tell my friends and my family how much I love them.Shelley Argent
In response to her prognosis, Shelley did something her family and friends didn’t expect. She threw a “Death and Dying” party.
“I have always believed that if I knew I was done, I would want to tell my friends and my family how much I love them,” Shelley said.
“I told everybody to leave their tears and their sorrow at the door and they had to come in and have a good time.”
After prolonged hospital stays, chemotherapy and other treatments, Shelly’s leukemia went into remission.
'You don't want to hear that from a doctor'
At 44, Simon Harvey was diagnosed with stage four squamous cell carcinoma – cancer in the neck and the head. He said that the delivery of the prognosis wasn’t what he wanted or needed at the time.
The doctor told him that without successful intervention, he’d survive six months. That was six years ago.
Simon Harvey with his three sons.
“He told me maybe a few too many times how sorry he was – you don’t want to hear that from a doctor.”
He was a little too apologetic for something outside of his control.Simon Harvey
While the Brisbane father was grateful for the doctor’s compassion, he wanted to find out the data. He wanted to know his real odds.
“You want to hear you’re in it... you can fight it, you can win. He was a little too apologetic for something outside of his control,” he said.
“I wanted the hard facts – good, bad, or indifferent.”
Outliving their prognosis
After Simon was treated successfully and cleared of cancer, his mental health was on the decline and as someone who had suffered childhood trauma, made him feel “unworthy of survivorship.”
To move forward, he decided to walk more than 2,400km from Brisbane to Melbourne.
Having previously done an interstate walk as a teenager to heal himself from a dark time, he wanted to walk again but this time dressed up as a superhero to help raise money for paediatric cancer research.
“I thought let’s dress up as Captain Australia and if you think Captain America with a beer gut, green and gold, yeah, you're pretty close,” Simon said.
As for Shelley, she celebrated her 72nd birthday this year with another big party.
“I had a drag queen, Candy Surprise [at the party] … she was amazing,” Shelley said.
“And I, again, invited all my friends and I think we shook the rafters of the neighbours … it was great fun.”
