COMMENTARY

What We Owe Patients While They Await a Cancer Diagnosis

Mark G. Kris, MD

Disclosures

April 23, 2020

This transcript has been edited for clarity.

Editor's note: This commentary is the third in a series on the wait time between cancer being diagnosed and treatment being initiated, and its effect on both patients and physicians.

Hello. I'm Mark Kris. I am here to talk again about the wait time between a cancer diagnosis being made and therapy being initiated.

We previously talked about the importance of working with our pathology colleagues to ensure that the right tests are being ordered and the right biopsies are being performed, including the prioritization of certain tests when we have insufficient tissue. This last part is on patients. While communication is critical with our colleagues, it is also critical with our patients.

I think patients are comforted when we explain why it takes as long as it does for cancer to be diagnosed. The week that it takes to get a result back from next-generation sequencing is not because it's sitting on a shelf somewhere. It takes time for the pathology team to extract the DNA and run it through the sequencer, and then interpret the data before an official report can be rendered. In our office, it is interesting how much of our day is taken up with these issues and how it affects our back office operation—the people who see and send the slides and those who wait for and then share the results. It's a huge amount of work.

We need to set timelines with our patients and explain them. We should say, "Look, it's going to take this long. However, if for some reason it doesn't happen, we have a plan to provide you with treatment."

For targeted therapies, there is virtually always an immuno-oncology or chemotherapy combination that can be given. People need to know that a treatment will be available to them in a finite period of time.

It's also important that you make appointments with your patients rather than call them. Patients need to sit down with you. By meeting with your patients, you can assess if there is a change in their physical condition suggesting that further waiting is not possible. It also can help in choosing the best therapy; for example, it may be more prudent to move ahead to palliative radiation, a procedure to remove a plural effusion, or chemotherapy if further waiting is not possible. And if you can't wait anymore, you can discuss this.

We need to pay attention to wait times and try to make them as efficient as we can. We don't want to leave patients hanging. We can say something like, "I'm going to see you on Tuesday. I'll make a decision where you're at in terms of your physical condition and whether we can wait further, and if waiting is not possible, we have a plan."

This is something that can allay a lot of anxiety—not only for our patients and their families but also for us as physicians.

Mark G. Kris, MD, is chief of the thoracic oncology service and the William and Joy Ruane Chair in Thoracic Oncology at Memorial Sloan Kettering Cancer Center in New York City. His research interests include targeted therapies for lung cancer, multimodality therapy, the development of new anticancer drugs, and symptom management with a focus on preventing emesis.

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