Adherence to your treatment plan increases your odds of having a good outcome.
Talking about five-year cancer survival rates has been critically important with every cancer patient I have worked with in my private practice as a clinical psychologist.
I worked with Marco, a 50-year-old entrepreneur who had been diagnosed with stage-three colon cancer.
The five-year survival rate for his type and stage of cancer was 76%.
I am curious about who is included in survival rate statistics. You know the cancer type and stage, but what geographical area is covered? All of Canada? All of the US? What period does the data cover? The last 10 years? The last 15? What age range is covered? Does the statistic include men and women or just men?
If the statistic includes everyone who has been diagnosed in Canada over the past 10 years, then people of all ages – from the very young to the very old – are included.
The oldest would possibly not have lived another five years because they were already close to end of life, regardless of their cancer diagnosis, so their presence lowers the statistic. Removing them from the cohort would mean that five year survival rate would increase.
If you’re older than the average person in your cohort when you are diagnosed, that doesn’t mean you can’t improve your own odds vis-à-vis the norm. Your level of compliance with your doctors’ recommendations is going to have a big impact on how well you make out.
I’m not suggesting you can guarantee your outcome if you do everything your doctors tells you to. I am, however, suggesting that you can improve your chances of a good outcome if you do everything you’re asked to do.
Cancer patients who refuse any form are treatment are included in five-year cancer survival rates.
These individuals are 100% non-compliant with their doctors’ recommendations, if they even met with their medical team, by definition. They also bring down survival rate statistics.
Others begin treatment but dropout for various reasons.
Some dropout because they are overwhelmed by side effects from their medications. They also bring down survival rate statistics. Marco was incredulous when we discussed this. He said, People refuse treatment? They stop treatment because of the side effects? Marco wanted to live. He was determined to adhere to his treatment plan and couldn’t fathom that everyone wasn’t like him. Marco was prepared to do anything asked of him to survive.
Do everything your doctors ask you to do to maximize your chances of having the best possible outcome.
It’s all well and good to say you will do everything your doctors ask you to do, but what if doing what you are asked isn’t possible? What if you can’t exercise? Or can’t keep your pills down because you vomit them back up?
In these situations, which likely arise for every cancer patient at some time during treatment, the most important thing to do is to keep your doctors informed about what’s happening.
Some patients hide their non-compliance from their medical team and say they’ve done everything they’ve been asked to do when they haven’t.
I know this to be true from experience. When I worked with patients with diabetes, for example, I would ask if they were monitoring their blood glucose levels correctly, and everyone would say yes.
But if I changed the question and asked, How many times a week are you not measuring your blood glucose levels?, most would tell me they only measured their blood glucose level once a day rather than the required three times a day.
It’s not unusual for people to lie to their doctors.
With this knowledge, I would like to encourage you to be different. Be forthcoming about the challenges you’re facing. Tell your doctors when you can’t do what you’ve been asked to do, and explain why. Your doctors know that some of what they ask their patients to do is really hard. They expects a percentage to be unsuccessful.
If you tell your doctors when you’re having difficulty, they can look for alternative ways to help you be compliant.
You will not be the first person who can’t complete your treatment protocol the way you’ve been asked to. Your doctors have a number of tricks up their sleeves. The solution might be something simple like prescribing a medication to counteract your nausea, or taking a break from chemotherapy for a few weeks if you’re exhausted before resuming treatment.
If your doctors ask you to exercise but you can’t, tell them so they can help you figure out how to be compliant. Ask for help to get back on track. Don’t shut down because you’ve hit a road block.
The story that follows illustrates the problem of non-compliance. Identifying details have been altered to protect privacy.
When I was completing my residency as a newly minted clinical psychologist, I became friends with Eliza. Eliza was another recent graduate and worked in the same department at the hospital.
Eliza was diagnosed with stage one breast cancer.
Eliza had surgery and was given the choice to have chemotherapy or not. She chose not to. So far so good.
She was prescribed Tamoxifen to help prevent a recurrence of her cancer. Her doctors told her she couldn’t smoke while taking Tamoxifen because smoking would inhibit the effectiveness of the medication.
Eliza had been a smoker for twenty-five years. Initially, she was compliant with her doctors’ directive and didn’t smoke.
In the year following her treatment, Eliza started smoking again. Rather than fighting her addiction, she stopped taking Tamoxifen.
I don’t know if Eliza sought help to stop smoking initially. I do know she didn’t reach out for help after she relapsed.
Your doctors expect to hear about lapses and relapses in compliance. Don’t just go silent.
A client told me that her mother had been diagnosed with a women’s cancer. I asked what kind of women’s cancer and my client said her mother didn’t know.
Both my client and I didn’t expect her mother to live very long because she wasn’t engaged in her own treatment. How compliant can you be if you don’t understand what you’re being treated for?
My client’s mother was most certainly afraid. Tell your doctors if you’re paralyzed with fear. Tell your doctors everything. If support isn’t forthcoming, considering engaging the help of a good psychologist to help you manage your fear.
Do whatever it takes to be compliant with your doctors’ recommendations so that you can improve your odds of having a good outcome.
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Dr Patricia Turner, PhD, Registered Psychologist in Private Practice in Calgary, Alberta.