To a patient, the difference between palliation and cure is black and white. For the oncologists, however, a large gray area does exist between palliation and cure and must be explained to patients. Accordingly, an in-depth discussion may be required even in cases in which the goal of radiation therapy is simply alleviating pain in metastatic bone disease or improving shortness of breath in cases of bronchial obstruction. When the goal is a moderate increase in median survival or an anecdotal cure, however, discussion with the patient becomes a balancing act between revealing the harsh realities of death and dying whereas attempting to simultaneously maintain some degree of hope. We radiation oncologists are rarely trained to give the truth or to discriminate what the "incurable" patient wants, or needs, to know-assuming he wants to be involved in the decision making. In such cases, a personalized approach to patient communication is indispensable for an effective doctor/patient understanding. Accurate and effective communication is essential, especially because oncologists may give potentially morbid treatment close to the end of life.
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