On ESPN, today is Jimmy V. Day, a day dedicated to continuing his mission of promoting cancer awareness and public funding. I’ve already heard a couple of guest say “they gave me 6 months to live” or “the doctors gave him 3 months”. I’m sure we’ve all heard others say similar things. Do doctors really do that? I would think that they would want to be as optimistic as possible.
The doctors don’t say it quite like that, but yes, IME and for cases considered terminal they will indicate what’s the “average expected lifetime” unless they see that the family is in refusal. It’s part of the information on likely outcomes of different courses of treatment.
My grandmother isn’t terminally ill, just terminally old, and we were told two years ago already that while she isn’t officially ill (there are things we know are wrong, but she’s the first one who isn’t interested in going through the discomfort of having them investigated), if anything serious happens she’s likely to go fast. It was part of the speech asking about end of life directives.
When Dad’s cancer came back for Round Three, he asked what would be the expectations with the different treatments available and without. The expected outcomes weren’t that much different, so he chose to go without.
My friend’s father had brain cancer when we were in high school. She was the only family member who wasn’t in complete denial, so she was given complete information. Her parents and brother didn’t. She was the only one of the four of them who happened to be a minor, but she was the only one who would handle things so with her mother’s consent she was made the family’s representative.
In ways they do. I was trying to get my mother into Hospice Care. In order to do that, the doctor had to agree that she had less than 6 months to live. Her doctors agreed to it.
The way they usually do it (at least these days) is to say “someone with your condition typically lives X months” or whatever time unit. At which point the patient or family may or may not continue to listen and hear any qualifications that may or may not be added (except you have additional condition Y so you might have less time or you’re unusually young and fit so you might have a little more time, something like that). It’s not really saying that YOU have exactly that much life left, just that statistically speaking that’s the norm. Not that the average person really understands statistics.
When someone goes into hospice they’re typically taken off all medications except those needed to keep them comfortable. Especially with cancer patients, who might have been taking some very harsh stuff as part of their treatment, this can eliminate medication side effects and the patient may briefly improve before entering a final decline. Or someone might be given the six months estimate then have some sudden downturn and die much quicker.
As I said in another thread, it’s a best guess. It’s an educated guess, but not more than that.
Totally depends on the doctor and, to some degree, the patient. Many doctors will wait until you ask. Some won’t even give that information to me, the nurse, which makes things awkward when patients ask me how much longer.
My well off patients seem to be informed more often than my poor ones, but whether that’s because they’re seeing different doctors, or because income correlates roughly to education, and/or they’re better listeners and/or they bring more capable advocates with them to appointments to help them process and retain information, I couldn’t say.
I tell my patients with active terminal diagnoses about that fact. Then I quote the odds, as best as I can figure them, usually in the context of something like “Half the people with your condition will be dead in 6 months, but some of them will live much longer than that”. Or “this type of cancer has a 95% mortality rate within a year of diagnosis”.
Yeah, I have a fun job sometimes.
Speaking as a poor person who used to be well off and who is also college educated (yet still poor) I think there is also a very strong bias against the poor. My experience has been that doctors speak very differently to me when they know/assume I am middle-class versus being on state aid. The assumption is all too often that poor people are stupid and irresponsible. Which is a societal bias they carry over into their practices, much like race bias, prejudice against the elderly, and so forth.
(No, not all doctors are like this. Just too many of them.)
It is a staple of woo that physicians routinely give patients X months to live, and are then flabbergasted/confounded/offended when they achieve cures or long-term remissions through the use of bowel cleanses or supplements.
I have never heard any physician including oncologists speak that way. As noted, honest appraisals of average clinical course are commonplace, but no one that I know of “gives” patients a finite death sentence.
My father was a doctor, so he may have had a bit more open communication with his physician. She told him he had about two years to live, which he beat by several years. He often reminded her of that.
When my wife was diagnosed with diffuse systemic sclerosis (scleroderma), she was told the five year mortality rate was 50%. She died five years later.
When I knew my husband was so sick that the prognosis couldn’t be good, I played hell trying to get any concrete answers about how long he had left. At that point, all we’d heard was that “worse case, he has about two years and best case as much as seven.” Well, he’d been in and out of the hospital over five times in two months, so I knew it was BS. I pressed both the ER admitting doc the last time and the hospitalist and got two different responses… between six weeks and six months. The only ones who ever told us the truth were the palliative care nurse (who always shot straight) and the hospice doctor when my husband obviously wasn’t coming out of that place.
So, in my experience, it’s rare that any physician will be totally conclusive with you. Liability wise, I can understand, but from an exhausted, worried, personal perspective, it’s absolute shit. I resorted to begging in the end. God bless that nurse.
My great aunt was told that her husband had 6-12 months to live after most of both of his lungs were removed back in 1965.
She has been dead for 10 years and he is still alive.
I have never heard a doctor tell a patient the timeline of death. And I have helped care for some ill folks, mostly heart disease. You have to listen between the lines. Palliative care is a clue you don’t have much time left. And hospice means sooner than later. But they just can’t say with any certainty. And they don’t like to say. In my experience it is the patient that must ask in clear terms. This only after the patient has realised that she is not long for this world.
My mother had severe bowel cancer.
The doctor sympathetically explained that she only had two choices:
- weeks of painful operations, with no guarantee of success
- a final pain-free week in a hospice
Mum wanted the second option and duly passed away with dignity.
My FIL had mesothelioma. His doctors told him that typically patients like him lived two to five years. He was a Glass Half-Empty type of guy, and said he figured he had two years. He lived almost exactly two years. I’ve often wondered: If they had told him three to five years, would he have lived three years?
About two years after FIL died, MIL was diagnosed with lung cancer. Her oncologist refused to give a prognosis. She got to the point where she was too weak to hold a telephone to her ear, but the oncologist wouldn’t sign for her to go on hospice, since “that would be giving up.”
Finally, she insisted on seeing the oncologist, who came to her house. MIL asked outright whether she was going to make it. Oncologist told her that she likely wouldn’t, and then gave the OK for hospice.
MIL was the kind of woman who didn’t believe in dragging things out. If something was going to happen, she wanted it to happen right away. She lived 16 hours after the oncologist told her it was pretty much hopeless.
Just within the last week I had an elderly relation given 6 months to live: he was dead two days later. So I wonder if doctors give their best estimates or are overly optimistic to give hope to relatives.
Yes doctors do this , a Dr. told my dad he had x numbers of years to live and my dad out lived the Dr. When I was a health aide doctors told my clients family members how long they had to live when they were terminally ill . A Dr. told one family their dad had six months to live , he had caner ,I ran into one of kid and they told me their dad only lived 3 months and if they had know he would live that long they would of spend more time with him. I never know a doctor to be right about how long as person has to live . I should be dead according to my Dr. about 8 years ago !
The last three consecutive cases of family members who were told variations of “expect around six more months to live” all died the next day.
It’s now something I dread hearing about someone.
My oncologists haven’t ever given me a timeline, other than the most general; they made it clear that this wasn’t something that was curable, but that with new treatments and all they would make sure I lived as long and as comfortably as possible. I had to look on the internet to find out the estimated lifespan of people with my disease/severity.
Also - I would like to put up a word about palliative care/hospice, since someone upthread brought it up. Palliative care does NOT mean that death is imminent or even close - it’s something that is recommended for anyone with a chronic condition. I’ve been under the care of a palliative team for about six months now, and they are absolutely wonderful. My oncologist focuses on treating the cancer; the palliative team focuses on helping me relieve symptoms, including side effects of chemo/radiation and making sure I have support from my friends and family (my husband and my mom go to the palliative appointments with me). The palliative team consists of an MD, an RN, and a LCSW, all of whom I meet with at the same time once a month. (As my condition gets worse that will increase, of course, but for the immediately forseeable future that’s all that’s needed.) They’ve also very gently helped me with things like my DNR and medical POA, making suggestions while being very clear that the choices are entirely my own.
Seriously, if anyone has or knows someone with a chronic, especially terminal condition - no matter what their life expectancy is - I’d recommend getting a palliative referral. These people know their stuff.
<<sigh>>
As expected, the thread has filled up with second, and even third-hand anecdotes of what docs are reported to have said.
My MIL recently expired of cancer. My wife went with her to her oncology appts. I attended by phone conference for two different oncologist visits. She saw 3 different oncologists, trying to find one who would tell her she didn’t have cancer. Each oncologist told her the basics, the straight facts, and the predicted survival rates for her situation. None of them gave her “6 months to live”, etc. but they let her know what her chances were. Openly, straightforwardly, and in basic language.
After each appointment, she reported to her friends and others that the docs had said she’d “be dead in 6 months”. Despite them taking pains to say it was possible for her to live over a year or more. At 6 months, she held a party, loudly declaiming that her doctors knew nothing because they all said she’d be dead, yet she was still alive. Her friends ate that up, and repeated her tales to all and sundry.
She repeated these statements many times over her final 7 months despite my wife and my sister-in-law repeatedly telling her what the doctors had actually said.
It’s often not what the doctors say that matters; it’s what the patient thinks they’re hearing. This happens frequently despite a LOT of effort by the doc to be clear, communicative, and informative.
edit: and I echo what Maggie said about palliative care. It improves quality of life tremendously.