Mind the label! Especially with low-risk neoplasms

Cristina Ferrario

According to a paper published in JAMA Oncology, the disease label has a profound influence on patient decision-making in the setting of low-risk malignant neoplasms and can also lead to overtreatment. In a discrete choice experiment, researchers from the University of Toronto asked 1.314 US residents to indicate their preferences between two hypothetical vignettes about the discovery of a small, low-risk thyroid lesion. “Vignettes varied on 3 attributes: disease label (cancer, tumor, or nodule); treatment (active surveillance or hemithyroidectomy); and risk of progression or recurrence (0%, 1%, 2%, or 5%)” said the authors, evaluating the preference weight of the cancer disease label compared with preference weights for other attributes. As a matter of fact, naming the disease as cancer, nodule or tumour can make the difference in patient perceptions and decisions independent of treatment or risk of progression or recurrence. “We found patients willing to accept a 4-percentage-point increased risk of progression or recurrence (from 1% to 5%) to avoid their disease being labeled as cancer in favour of nodule” researchers wrote, underlining that the preference for tumour over cancer was less strong. They concluded that removing the word cancer from the disease label of low risk lesions may reduce the likelihood for the patient to choose aggressive treatments. “Could we really minimise as a noncancer all these small lesions?” asked Elise C. Kohn and Shakun Malik, from the Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland in a related editorial. “If there are malignant cells in the specimen, it is a cancer” they claimed, suggesting that oncologists should “take the time and use the appropriate language to convey accurately risks and recommendations to the patient and to allow the patient to make an informed decision, minimally influenced by emotion”. What’s in a name? That which we call a rose, by any other name would smell as sweet Shakespeare wrote in his famous poem. But it seems that what was true for the Bard could be somehow wrong – or at least arguable – in modern oncology. The debate is still open.

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