Supportive Care in Cancer

, Volume 16, Issue 7, pp 803–811 | Cite as

“What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits

  • Wendy G. Anderson
  • Stewart C. Alexander
  • Keri L. Rodriguez
  • Amy S. Jeffreys
  • Maren K. Olsen
  • Kathryn I. Pollak
  • James A. Tulsky
  • Robert M. Arnold
Original Article



Cancer patients have high levels of distress, yet oncologists often do not recognize patients’ concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists.

Materials and methods

As part of the Studying Communication in Oncologist–Patient Encounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content.


Patients verbally expressed negative emotion in 17% of the visits. The most commonly used words were: “concern,” “scared,” “worried,” “depressed,” and “nervous.” Types of emotion expressed were: anxiety (46%), fear (25%), depression (12%), anger (9%), and other (8%). Topics about which emotion was expressed were: symptoms and functional concerns (66%), medical diagnoses and treatments (54%), social issues (14%), and the health care system (9%). Although all patients had terminal cancer, they expressed negative emotion overtly related to death and dying only 2% of the time.


Patients infrequently expressed negative emotion to their oncologists. When they did, they typically expressed anxiety and fear, indicating concern about the future. When patients use emotionally expressive words such as those we described, oncologists should respond empathically, allowing patients to express their distress and concerns more fully.


Patients Cancer Emotion Distress Communication 


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Wendy G. Anderson
    • 1
  • Stewart C. Alexander
    • 2
    • 3
    • 4
  • Keri L. Rodriguez
    • 5
    • 6
    • 7
  • Amy S. Jeffreys
    • 4
  • Maren K. Olsen
    • 4
    • 8
  • Kathryn I. Pollak
    • 9
    • 10
  • James A. Tulsky
    • 2
    • 3
    • 4
    • 9
  • Robert M. Arnold
    • 5
    • 6
    • 11
  1. 1.Department of Medicine, Division of Hospital Medicine and Palliative Care ProgramUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of MedicineDuke University Medical CenterDurhamUSA
  3. 3.Center for Palliative CareDuke University Medical CenterDurhamUSA
  4. 4.Center for Health Services ResearchDurham VA Medical CenterDurhamUSA
  5. 5.Division of General Internal Medicine, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  6. 6.Institute for Doctor–Patient CommunicationUniversity of Pittsburgh School of MedicinePittsburghUSA
  7. 7.Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghUSA
  8. 8.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA
  9. 9.Cancer Prevention, Detection and Control Research ProgramDuke Comprehensive Cancer CenterDurhamUSA
  10. 10.Department of Community and Family MedicineDuke University Medical CenterDurhamUSA
  11. 11.Institute to Enhance Palliative CareUniversity of Pittsburgh School of MedicinePittsburghUSA

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