Alberto Sobrero_Doctor-Patient

Evidence based medicine is now easier, but often still misinterpreted

Latest advances in cancer care has impacted on the doctor-patient relationship

In the last five years, the outstanding results of clinical research on targeted agents and immunotherapy have completely changed the scenario for the management of several solid neoplasms, but also in the doctor-patient relationship. Today, the median survivals of melanoma, HER2 positive breast cancer, prostate and renal cell cancer have been extended by 5 times compared to those reported 10-20 years ago. Also, thanks to checkpoints inhibitors plateaus in the order of 30% at 3-5 years and beyond have been achieved, leaving hopes for cure in aggressive diseases such as NSCLC, melanoma and MSI-high colorectal cancer.  

Increased chances of a better prognosis have significantly facilitated shared decision-making in oncology. Despite the “bad news” of a cancer diagnosis or relapse, information to be given to patients has become less challenging and unlikely to be rejected or misinterpreted by patients due to their emotional status or denial. This is observed not only in settings when a cure is a concrete possibility, but also in stage IV, where the risk of generating unrealistic expectations in patients is higher. 

Fully informed, engaged and empowered patients stand on one side of the shared decision-making coin. On the opposite one, the medical oncologist with his or her clinical judgement. Whereas patients should be put in the position to freely express their preferences, values and beliefs on the antineoplastic treatments recommended, clinicians should take them into consideration and break the habit to rely merely on oncology guidelines. In fact, true evidence-based medicine (EBM), which nurtures a successful doctor-patient communication leading to better outcomes for the patient ultimately, consists of three domains of which only one reflects the need to stick to the results of solid clinical trials, well-formulated clinical guidelines and recommendations. The remaining two emphasise the central role of the experienced physician and act as a reminder that our medical choices must be shared, understood and accepted by the patient who provides further guidance to the difficult process of tailoring care. 

Despite the huge advances in cancer care, evidence-based medicine is still misinterpreted as the search for what is best for the patient through numbers, deltas and p values, leaving all the human aspects behind.  

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