Disclosure of the diagnosis of cancer to patients is a difficult task for physicians in developing countries. Family members often oppose truth telling. The aim of this study was to evaluate the incidence of the "do not tell" attitude in a general population of cancer patients and to explore the factors affecting the attitude of cancer patients' relatives about honest disclosure. Using a questionnaire, relatives of 150 patients with recently diagnosed cancer were interviewed. Of the relatives, 66% did not want the diagnosis to be disclosed. Male gender of the patient, a diagnosis of a non-breast cancer malignancy, the presence of stage IV disease, no previous request for disclosure by the patient, insufficient knowledge of the relative about cancer in general, and stronger religious belief of the relative were associated with greater likelihood of the relative having a "do not tell" attitude in univariate analyses ( P=0.032, P=0.000, P=0.051, P=0.021, P=0.128, and P=0.058, respectively). In a multivariate analysis, the diagnosis of a non-breast cancer malignancy, and insufficient knowledge of the relative about cancer in general retained their significance (exp(B)=14.77, P=0.000; exp(B)=3.04, P=0.01, respectively). Differences among different countries and cultures are discussed.

Professional training in breaking bad news is important and is associated with the self-reported truth-telling practices of physicians.

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In their search for a cure, a significant number of cancer patients use nonproven treatment (NPT) methods. However, little is known about patient and disease characteristics associated with the use of these methods. In this trial, we evaluated the prevalence of and the factors associated with the usage of nonproven cancer remedies in a teaching hospital in Turkey. A self-administered questionnaire was given to 135 cancer patients attending the outpatient clinics of a medical oncology department. Patients' demographic data, their usage of nonproven methods, and possible contributing factors were explored. Our cohort mainly comprised poor patients with only primary school education. Overall, 50% of our patients had used or were using NPT methods. Medicinal herbs (mainly stinging nettle) were the most frequently used remedy. In contrast, such "complementary therapies" as exercise, relaxation, and meditation were not employed. In multivariate analysis, only duration of disease was found to be significantly associated with NPT utilization [P=0.05, relative risk (RR)=1.94]. In addition, patient education level was marginally significant (P=0.07, RR=0.36). Apart from long duration of disease and being better educated, no other clinical, social, economic and cultural factors evaluated were associated with the use of NPT in our group of Turkish patients. Since these treatments are sometimes costly and have questionable efficacy and toxicity, proper scientific trials are needed to clarify whether such methods have a real role in cancer management.

The object of this study was to investigate how the information status with regard to diagnosis, in addition to social and clinical factors, influenced emotional functioning and quality of life in a group of cancer patients in Turkey. A consecutive sample of 100 cancer patients being treated for different diagnoses in a tertiary care centre were prospectively evaluated. Data on patient disease and social characteristics, clinical factors, and scores on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were analysed by logistic regression models. A significant proportion (44%) of the patients did not know of their diagnosis of cancer. The scores on functional and symptom scales and global health status/quality of life according to QLQ-C30 did not differ according to the information given or not given on diagnosis. However, the independently significant determinants of good emotional functioning were male gender (P=0.002), low serum alanine transferase levels (P=0.025), good social functioning (P=0.002), and the absence of constipation (P=0.005). In Turkey, it is still common for cancer patients not to be informed of their diagnosis, and there is a great need to improve this situation. Honest disclosure of the truth does not worsen any dimension of quality of life in general or emotional functioning in particular. On the contrary, those with hepatic dysfunction, female gender, poor social functioning and constipation are the ones at increased risk of poor emotional functioning, and these patients may benefit from psychological screening.