China’s growing cancer burden often kept secret from patients


Doctors start to rethink practice after studies show disclosure helps treatment





Diagnosed with lung cancer at the age of 71, Du Yingfen died of the disease last year not knowing her diagnosis, as her family kept the news from her for two years.

“We just said it was a rheumatism,” said her husband Xu Shengxun.

Keeping a cancer diagnosis from patients in an attempt to shield them from worry is common in China. But the country’s rising cancer burden — 4.3m cases were diagnosed in 2015, twice the 2000 figure and more than any other country — has led some doctors to rethink the practice on the grounds that it hinders treatment.

The rise in cases has been driven by an ageing population and the prevalence of lifestyle factors such as smoking, with lung and stomach cancers the most common.


Research published last year from a survey in central Henan province found that 58 per cent of oesophageal cancer patients were not informed of their diagnosis. Other studies put the figure around 50 per cent.

Doctors tend to first disclose a cancer diagnosis to family members without the patient present, according to a recent survey of Chinese physicians. One senior oncologist told the researchers: “In China seeing a doctor is like [seeing] a network of families. It indeed plays a very big role during the treatment.”

Relatives said their reason for concealing the diagnosis was a belief that worry caused by the diagnosis could make the condition worse, or that they were unable to afford adequate treatment.

Deception can be complex. When Zhang Yufang, 84, was diagnosed with thyroid cancer in 2009 after discovering a lump on her neck, her daughter Zhang Meiqing asked a friend to forge a document calling it a “benign tumour”.==>Bakat Tukang Tipu mama sendiri ditipu,benar2 put hao waaa!!!





After an operation to remove the tumour proved ineffective, family members rejected chemotherapy because of “the thought that she would realise she had cancer as soon as she entered the therapy room”, Ms Zhang said.

Following a series of physical attacks on doctors by disgruntled patients and family members, physicians also worry that they could be held responsible for any negative reaction to the diagnosis. That is despite research showing that more than 70 per cent of patients would wish to be informed of any diagnosis.

“It’s not like the west where you have to inform the patient of the basic diagnosis immediately. We are trying to improve that,” said Jiang Bo, director of gastroenterology at a hospital in Beijing. “If patients could choose their own treatment it would be better, we can see that from the west.”

Mr Jiang’s view was reinforced by a study last year that showed disclosure of diagnosis to most Chinese lung cancer patients does not induce or aggravate anxiety or depression.


“It might be beneficial in the early stages, but later it can only create more anxiety and suspicion that is not favourable to treatment,” argued Huang Boyan, an oncology researcher at Sichuan University.

Ms Huang said practices are changing due to the increased influence of “western culture” and medical ethics.

Chinese physicians tend to favour disclosure more than family members, and attitudes have not changed in the Zhang household. Zhang Yufang has discovered new lumps, which doctors said follow the spread of cancer to her lungs and bones.

But her family told her they were harmless nodules, with her daughter asking her rhetorically: “If you really had cancer, how could you have survived so long?”


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