The Consequences of Name-Calling

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Use of the word ‘cancer’ in diagnosis may lead a person to choose more aggressive treatments.
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Receiving a diagnosis of cancer can increase a person’s acceptance of aggressive treatments and the risks associated with these treatments.

Whether it’s at home, work or in the school yard, we all know being called a name can create emotions that affect how we respond and act.

Similarly, in health care, the name used to describe a condition or disorder can affect the course of treatment we choose. This is a key finding of new research from the Toronto General Hospital Research Institute (TGHRI).

Dr. David Urbach, TGHRI Senior Scientist and surgeon-in-chief at Women's College Hospital, discovered that adults tend to opt for more extreme and potentially more harmful treatments when the diagnosis contains the word cancer.

Despite its aggressive and lethal connotations, cancer is discovered in many forms: sometimes it is a tumour that requires extensive treatment; sometimes it is a bit of abnormal tissue that is barely detectable.

In the study, Dr. Urbach and his colleagues conducted a survey with over a thousand adult volunteers. Participants were asked to imagine having a small lump in their neck and visiting their doctor to discuss the results of a biopsy.

The participants were presented with several pairs of scenarios. For example, scenario one might call the lump a nodule, recommend surgery and estimate a 5% chance that the condition would come back; scenario two might label the lump as cancer, recommend to watch and wait if it becomes worse, and estimate a 1% chance that the condition would come back. In all scenarios, the survival rate was greater than 99%.

"We found that these hypothetical treatment preferences were greatly affected by whether the diagnosis contained the word cancer," describes Dr. Urbach. "Study participants were willing to accept more invasive treatments and a worse health outcome to avoid being labelled as having cancer."

"These results suggest that the name that we give to small or low-risk cases of tissue abnormality can lead to overtreatment, which can do more harm than good," explains Dr. Urbach. "In such cases, health care professionals should be mindful of the anxiety-causing connotations of the cancer label, and should place emphasis on weighing the risks and benefits of the treatment."

This work was supported by the Toronto General & Western Hospital Foundation and the Canadian Institutes of Health Research.

Dixon PR, Tomlinson G, Pasternak JD, Mete O, Bell CM, Sawka AM, Goldstein DP, Urbach DR. The Role of Disease Label in Patient Perceptions and Treatment Decisions in the Setting of Low-Risk Malignant Neoplasms. JAMA Oncol. 2019 Mar 21. doi: 10.1001/jamaoncol.2019.0054.

Dr. David Urbach, Senior Scientist, Toronto General Hospital Research Institute