Striking the right tone: Communicating with cancer patients

Even experienced oncologists find it difficult to communicate with people suffering from cancer. However, dialogue can be of existential importance for those affected.

Addressing high psychological stress in cancer patients

Around 20 per cent of patients suffer from depression and 10 per cent from anxiety disorders. The prevalence is therefore higher than in the general population.
Progression anxiety, i.e. the fear of a recurrence or progression of the disease, is common in oncological patients.
The symptoms can occur during the course of the disease, but can also persist for years after the end of treatment.
Depression and anxiety disorders can have a negative impact on quality of life, adherence to treatment, cancer survival and treatment costs.

How do I recognise anxiety and depression?

According to ICD-10, there are clear diagnostic criteria for depression and anxiety disorders. Simple screening instruments have proven to be useful in everyday clinical practice and can be used to quickly assess the severity of symptoms. The PHQ-4, for example, is easy to use and assesses psychological stress using four simple questions.

Depending on the results, a stepped-care model can then be used. It ranges from regular oncological care with low levels of stress to acute psychiatric care in crisis situations.

Which communication techniques are helpful?

Even the doctor-patient dialogue as part of regular care can have a huge impact. The following basic communication skills are required to give patients a sense of security and relieve them emotionally:

"Pacing" means meeting the other person where they are. This includes providing appropriate information without overplaying the seriousness of the situation.
"Leading" means using concrete suggestions for action to take away the feeling of powerlessness.
Re-orientation exercises help to locate the patient in the here and now by directing attention to the five senses.
Finally, "Mastery" is the recourse to previous crises that the patient has overcome and can now orientate themselves on.

These dialogue techniques alone can have an antidepressant and anxiolytic effect on those affected.

Oncologists now have their own communication training programmes for successful doctor-patient discussions. One example is the COMSKIL model. In addition to specific communication techniques, the programme also teaches which framework conditions should be taken into account during the conversation. This includes non-verbal behaviour such as facial expressions and eye contact, but also comforting gestures such as offering tissues. All of this can reassure those affected and build trust.

Key take-away for medical practice

Psycho-oncology is now an integral part of oncological care. Every doctor who treats cancer patients should specifically ask about psychological stress and be trained in empathic, patient-centred communication.

Sources

[In German only] Weißflog G et al. Kommunikativer Umgang mit Angst und Depressivität bei Krebspatienten im Arzt-Patienten-Gespräch. Onkologie 2023; 29: 801–807.
Hartung TJ, Kissane D, Mehnert A (2018) COMSKIL communication training in oncology – adaptation to German cancer care settings. In: Goerling U, MehnertA (Hrsg) Psycho-Oncology. RecentResults in Cancer Research. Springer, Cham.