Skip to main content

Advertisement

SpringerLink
Log in

Exceptional patients and communication in cancer care—are we missing another survival factor?

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Objective

There is increased awareness of the issue of exceptional survival beyond expectations among cancer patients with poor prognosis, and researchers are starting to look closely at this phenomenon. In this study, we explored the perceptions of these “exceptional patients” as to their understanding and insight into their unusual experience.

Methods

We used a qualitative approach consisting of in-depth, open-ended interviews with exceptional patients in two locations, Texas and Israel, from 2007 to 2014. The interviews were audio-recorded and qualitatively analyzed, and gave rise to illness narratives entailing detailed descriptions of patients experience over the course of their disease and treatment. A qualitative content analysis focusing on contextual meaning was utilized.

Results

Twenty-nine patients participated in our study. The mean years since diagnosis was 9.55 years (range, 4–23 years). All patients had received conventional treatment, including surgery, chemotherapy, and radiation therapy. One of the prevailing themes in these interviews was related to the patient-doctor relationship. Most participants mentioned that the support they received from one or more physicians was a crucial factor for their exceptional survival.

Conclusion

The significance of patient-doctor relationship in cancer survival requires further research. This research is especially important as it adds to the current trend of patient centered care and points to the added value of relationship between health providers and patients. This relationship, as perceived by these exceptional patients, can be a factor that adds to improved survival in cancer care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The Centers for Disease Control and Prevention (CDC): Basic Information about Cancer Survivorship website. http://www.cdc.gov/cancer/survivorship/basic_info/ Accessed November 21, 2015.

  2. Gotay CC, Isaacs P, Pagano I (2004) Quality of life in patients who survive a dire prognosis compared to control cancer survivors. Psycho-Oncology 13(12):882–892

    Article  PubMed  Google Scholar 

  3. Abdelrazeq AS (2007) Spontaneous regression of colorectal cancer: a review of cases from 1900 to 2005. Int J Color Dis 22(7):727–736

    Article  Google Scholar 

  4. Hirshberg C, O'Reagan B (1993) Spontaneous remission: an annotated bibliography. Institute of Noetic Sciences, Petaluma, CA

    Google Scholar 

  5. Hirshberg C, Barasch MI. Remarkable recovery. Reprint ed. Riverhead Trade: New York, 1996.

  6. Barasch MI (2008) Remarkable recoveries: research and practice from a patient's perspective. Hematolology/Oncology Clinics of North America 22(4):755–766

  7. Turner KA (2014) Radical remission: surviving cancer against all odds. Harper Collins Publishers, New York

    Google Scholar 

  8. Launso L, Drageset BJ, Fonnebo V, et al. (2006) Exceptional disease courses after the use of CAM: selection, registration, medical assessment, and research. An international perspective. J Altern Complement Med 12(7):607–613

    Article  PubMed  Google Scholar 

  9. Cole WH, Everson TC (1956) Spontaneous regression of cancer: preliminary report. Ann Surg 144(3):366–383

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Junquera L, Torre A, Vicente JC, Garcia-Consuegra L, Fresno MF (2005) Complete spontaneous regression of Merkel cell carcinoma. Annals of Otology Rhinology, and Laryngology 114(5):376–380

    Article  Google Scholar 

  11. Ohtani H, Yamazaki O, Matsuyama M, et al. (2005) Spontaneous regression of hepatocellular carcinoma: report of a case. Surg Today 35(12):1081–1086

    Article  PubMed  Google Scholar 

  12. Zahl PH, Maehlen J (2005) Model of outcomes of screening mammography: spontaneous regression of breast cancer may not be uncommon. Br Med J 331(7512):350–351

    Article  Google Scholar 

  13. Ventegodt S, Morad M, Hyam E, Merrick J (2004) Clinical holistic medicine: induction of spontaneous remission of cancer by recovery of the human character and the purpose of life (the life mission). Sci World J 4:362–377

    Article  Google Scholar 

  14. Gaussmann AB, Imhoff D, Lambrecht E, Menzel C, Mose S (2006) Spontaneous remission of metastases of cancer of the uterine cervix. Onkologie 29(4):159–161

    PubMed  Google Scholar 

  15. Zahl PH, Maehlen J (2006) Do model results suggest spontaneous regression of breast cancer? International Journal of Cancer 118(10):2647–2649

    Article  PubMed  Google Scholar 

  16. Iihara K, Yamaguchi K, Nishimura Y, Iwasaki T, Suzuki K, Hirabayashi Y (2004) Spontaneous regression of malignant lymphoma of the breast. Pathol Int 54(7):537–542

    Article  PubMed  Google Scholar 

  17. Everson TC (1964) Spontaneous regression of cancer. Annals of the New York Academy of Sciences 114:721–735

    Article  Google Scholar 

  18. Horii R, Akiyama F, Kasumi F, Koike M, Sakamoto G (2005) Spontaneous “healing” of breast cancer. Breast Cancer 12(2):140–144

    Article  PubMed  Google Scholar 

  19. Everson TC, Cole WH (1959) Spontaneous regression of malignant disease. J Am Med Assoc 169(15):1758–1759

    Article  CAS  PubMed  Google Scholar 

  20. Challis GB, Stam HJ (1990) The spontaneous regression of cancer. A review of cases from 1900 to 1987. Acta Oncologica 29(5):545–550

    Article  CAS  PubMed  Google Scholar 

  21. Jerry LM, Challis EB (1984) Oncology, 3rd edn. W.B. Saunders, Philadelphia, PA

    Google Scholar 

  22. Frenkel M, Ari SL, Engebretson J, et al. (2011) Activism among exceptional patients with cancer. Supportive Care in Cancer 19(8):1125–1132

    Article  PubMed  Google Scholar 

  23. Engebretson JC, Peterson NE, Frenkel M (2014) Exceptional patients: narratives of connections. Palliative Supportive Care 12(4):269–276

    Article  PubMed  Google Scholar 

  24. Franklin CI. Spontaneous Regression in Cancer. In Prolonged Arrest of Cancer, Stoll BA (ed.). JB Wiley: Toronto: 1982; 103–116.

  25. National Cancer Institute website. Exceptional Responders Initiative. http://www.cancer.gov/news-events/press-releases/2014/exceptionalrespondersqanda Accessed March 6, 2016.

  26. Frenkel M, Gross S, Popper Giveon A, Sapire K, Hermoni D (2015) Living outliers: experiences, insights, and narratives of exceptional survivors of incurable cancer. Future Oncol 11(12):1741–1749

    Article  CAS  PubMed  Google Scholar 

  27. Temel JS, Greer JA, Muzikansky A, et al. (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363:733–742

    Article  CAS  PubMed  Google Scholar 

  28. Epstein RM, Street RL Jr (2007) Patient-centered communication in cancer care: promoting healing and reducing suffering. NIH publication no. 07–6225. National Cancer Institute, Bethesda, MD

    Google Scholar 

  29. Street RL Jr, Makoul G, Arora NK (2009) Epstein RM how does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 74(3):295–301

    Article  PubMed  Google Scholar 

  30. Arora NK (2003) Interacting with cancer patients: the significance of physicians' communication behavior. Soc Sci Med 57(5):791–806

    Article  PubMed  Google Scholar 

  31. Street RL Jr, Voigt B (1997) Patient participation in deciding breast cancer treatment and subsequent quality of life. Med Decis Mak 17(3):298–306

    Article  Google Scholar 

  32. Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR (1999) Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol 17(1):371–379

    CAS  PubMed  Google Scholar 

  33. Takayama T, Yamazaki Y (2004) How breast cancer outpatients perceive mutual participation in patient-physician interactions. Patient Educ Couns 52:279–289

    Article  PubMed  Google Scholar 

  34. Bakker DA, Fitch MI, Gray R, Reed E, Bennett J (2001) Patient-health care provider communication during chemotherapy treatment: the perspectives of women with breast cancer. Patient Educ Couns 43:61–71

    Article  CAS  PubMed  Google Scholar 

  35. Enzman Hines M, Wardell DW, Engebretson J, Zahourek R, Smith MC (2015) Holistic nurses’ stories of healing of another. Journal of Holistic Nursing 33(1):27–40

    Article  PubMed  Google Scholar 

  36. Klienman A (1988) The illness narratives: suffering, healing, and the human condition. Basic Books, New York

    Google Scholar 

  37. Lieblich A, Tuval-Mashiach R, Zilber T (1988) Narrative research: reading, analysis, and interpretation. Sage Publications, Thousand Oaks, CA

    Google Scholar 

  38. Riessman CK (2008) Narrative methods or the human sciences. Sage Publications, Thousand Oaks CA

    Google Scholar 

  39. Egolf B, Lasker J, Wolf S, Potvin L (1992) The Roseto effect: a 50-year comparison of mortality rates. Am J Public Health 82(8):1089–1092

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Reynolds P, Boyd PT, Blacklow RS, et al. (1994) The relationship between social ties and survival among black and white breast cancer patients. National Cancer Institute black/white cancer survival study group. Cancer Epidemiol Biomark Prev 3(3):253–259

    CAS  Google Scholar 

  41. Goodwin JS, Hunt WC, Key CR, Samet JM (1987) The effect of marital status on stage, treatment, and survival of cancer patients. J Am Med Assoc 258(21):3125–3130

    Article  CAS  Google Scholar 

  42. Churchill LR, Schenck D (2008) Healing skills for medical practice. Ann Intern Med 149(10):720–724

    Article  PubMed  Google Scholar 

  43. Stajduhar KI, Thorne SE, McGuinness L, Kim-Sing C. Patient perceptions of helpful communication in the context of advanced cancer. J Clin Nurs. 2010; 19(13–14):2039–47.

  44. Thorne SE, Hislop TG, Armstrong EA, Oglov V. Cancer care communication: the power to harm and the power to heal? Patient Educ Couns 2008; 71(1):34–40.

  45. Martino J, Pegg J, Frates EP. The connection prescription using the power of social interactions and the deep desire for connectedness to empower health and wellness. American Journal of Lifestyle Medicine. Published online before print doi:10.1177/1559827615608788. October 7, 2015

Download references

Acknowledgments

The authors would like to thank all the patients that participated in this study, especially for their openness and willingness to share their stories for the benefit of others. We also thank all the physicians that took care of these patients for their participation in recruiting these patients. The authors would like to thank the Reliable Cancer Therapies Fund (Verbier, Switzerland), a nonprofit organization, for partially supporting the study.

Author information

Author notes

  1. Moshe Frenkel

    Present address: The Complementary and The Integrative Medicine Unit, The Institute of Oncology, Meir Medical Center, Kfar Saba, Israel

Authors and Affiliations

  1. The Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Moshe Frenkel

  2. School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Joan C. Engebretson & Noemi E. Peterson

  3. The Minerva Center for End-of-Life Studies, Tel Aviv University, Tel Aviv, Israel

    Sky Gross

  4. David Yellin Academic College, Jerusalem, Israel

    Ariela Popper Giveon

  5. Department of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Kenneth Sapire

  6. Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University and Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel

    Doron Hermoni

Authors
  1. Moshe Frenkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joan C. Engebretson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sky Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noemi E. Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ariela Popper Giveon
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenneth Sapire
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Doron Hermoni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Moshe Frenkel.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Financial support

Partial support was obtained from The University of Texas MD Anderson Cancer Center (Houston, Texas), The Reliable Cancer Therapies Fund (Verbier, Switzerland) and Clalit Health Services (Tel Aviv, Israel).

Additional information

Affiliation 1 relates to data collected at 2007–2009 for Dr Frenkel

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Frenkel, M., Engebretson, J.C., Gross, S. et al. Exceptional patients and communication in cancer care—are we missing another survival factor?. Support Care Cancer 24, 4249–4255 (2016). https://doi.org/10.1007/s00520-016-3255-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-016-3255-6

Keywords

Search

Navigation