Maurie Markman, MD
There are certain commonly used terms in the realm of oncology that may result in unintended consequences and should be considered carefully before being employed in conversation or in writing. When it comes to words clinicians use in talking with patients and their families, that list starts with the word “cure.” Of course, we know this word means the cancer is gone and will never return.
Yet one of the most common questions that oncologists hear from patients must be, “Am I cured?” It is difficult to provide an objectively valid answer to this question, for as much as one may wish to definitively answer “yes,” the evidence in a given clinical setting may strongly suggest the danger associated with prematurely stating what that patient and family yearn to hear. As a result, great caution is advised when discussing the concept of a cure with a patient following a cancer diagnosis and in carefully distinguishing expressions such as “you are hopefully cured” or “you have a good chance of being cured” from the definitive “you are cured.”
Another term fraught with the potential for serious misinterpretation is the increasingly used expression “actionable” in reference to molecularly defined abnormalities within a patient’s cancer. It is common practice these days for commercial molecular laboratories to accompany their list of observed genomic findings with a statement that “action” is possible against 1 or more abnormalities. The problem is that the definition of “actionable” used by these entities is often substantially different from what might be considered reasonable by an objective external observer.
Evaluating a “Conflict of Interest”
Next, we turn to the term “conflict of interest,” which is commonly used to describe a clinician or clinical investigator who has received financial payment from a commercial interest (eg, pharmaceutical, biotech, device company) for specific services such as advising on clinical trial design or serving as a member of a data safety and monitoring committee or a medical advisory committee. Although use of the expression without an additional modifier, such as “possible” or “potential,” may imply to some the existence of an actual conflict of interest, the mere listing of an individual’s name and the organizations providing payment is not problematic in most circumstances.
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