该不该向癌症患者告知病情

Diagnosed with lung cancer at the age of 71, Du Yingfen died of the disease last year not knowing nosis, as her family kept the news from her for two years.

杜映芬（音）在71岁时被诊断患上了肺癌，她于去年死于这种疾病。不过，一直到去世，她也不知道自己得的是什么病，因为她的家人把诊断结果向她隐瞒了两年。

“We just said it was a rheumatism,”said her husband Xu Shengxun.

“我们只告诉她说，她得的是风湿病，”她的丈夫许圣训（音）说。

Keeping a cancer diagnosis from patients in an attempt to shield them from worry is common in China. But the country’s rising cancer burden — 4.3m cases were diagnosed in 2015, twice the 2000 figure and more than any other country — has led some doctors to rethink the practice on the grounds that it hinders treatment.

向癌症患者隐瞒诊断结果以免他们担忧，在中国是常见的做法。但是，随着中国的癌症负担逐年增加——2015年确诊病例达到430万，是2000年的两倍，而且超过其他任何国家——一些医生开始反思这种做法，理由是隐瞒病情影响了治疗。

The rise in cases has been driven by an aging population and the prevalence of lifestyle factors such as smoking, with lung and stomach cancers the most common.

导致癌症病例上升的因素包括人口老龄化，以及吸烟等生活方式因素的普遍性，后者意味着肺癌和胃癌最为常见。

Research published last year from a survey in central China’s Henan province found that 58 per cent of oesophageal cancer patients were not informed of their diagnosis. Other studies put the figure around 50 per cent.

去年发表的研究结果显示，在中国中部的河南省进行的研究发现，58%的食道癌患者没有被告知诊断结果。其他研究结果显示，这一比例在50%左右。

Doctors tend to first disclose a cancer diagnosis to family members without the patient present, according to a recent survey of Chinese physicians. One senior oncologist told the researchers: “In China seeing a doctor is like [seeing] a network of families. It indeed plays a very big role during the treatment.”

根据最近一项对中国医生的调查，医生往往会在患者不在场的情况下先向家属披露癌症诊断结果。一位资深的肿瘤专家告诉研究人员，“在中国，看医生就像是一次家庭成员的集会。家庭在治疗过程中确实扮演着非常重要的角色。”

Relatives said their reason for concealing the diagnosis was a belief that worry caused by the diagnosis could make the condition worse, or that they were unable to afford adequate treatment.

亲属表示，隐瞒诊断结果的理由是，他们认为诊断结果引发的担心可能会使患者的病情恶化，或者他们负担不起充分治疗的费用。

Deception can be complex. When Zhang Yufang, 84 was diagnosed with thyroid cancer in 2009 after discovering a lump on her neck, her daughter Zhang Meiqing asked a friend to forge a document calling it a “benign tumour”.

欺骗患者可能颇费周折。2009年，84岁张玉芳（音）被确诊患有甲状腺癌。她的女儿张美清（音）请朋友伪造了一份“良性肿瘤”的诊断书。

After an operation to remove the tumour proved ineffective, family members rejected chemotherapy because of “the thought that she would realise she had cancer as soon as she entered the therapy room”, Ms Zhang said.

在一次摘除肿瘤的手术没有取得预期效果后，家属拒绝了化疗，因为他们认为“一进入治疗室，她就会意识到自己患了癌症，”张美清说。

Following a series of physical attacks on Chinese doctors by disgruntled patients and family members, physicians also worry that they could be held responsible for any negative reaction to the diagnosis. That is despite research showing that more than 70 per cent of patients would wish to be informed of any diagnosis.

在发生一系列心怀不满的患者和家属袭击医生的事件后，中国的医生也担心自己因为诊断引发的负面反应而被追究责任。尽管研究表明，超过70%的患者希望被告知诊断结果。

“It’s not like the west where you have to inform the patient of the basic diagnosis immediately. We are trying to improve that,” said Jiang Bo, director of gastroenterology at a hospital in Beijing. “If patients could choose their own treatment it would be better, we can see that from the west.”

“在西方，你必须立即向病人告知基本诊断结果，但中国的做法不一样。我们正在努力改进，”北京某医院的肠胃科主任江波（音）说。“如果患者可以选择自己的治疗方案，治疗效果会更好，我们可以从西方的资料看到这一点。”

Mr Jiang’s view was reinforced by a study last year that showed disclosure of diagnosis to most Chinese lung cancer patients does not induce or aggravate anxiety or depression.

去年的一项研究结果支持了江波的观点。研究显示，被告知诊断结果的大多数中国肺癌患者并没有出现或加重焦虑或抑郁。

“It might be beneficial in the early stages, but later it can only create more anxiety and suspicion that is not favourable to treatment,” argued Huang Boyan, an oncology researcher at China’s Sichuan University.

“（对病人隐瞒病情）在早期阶段可能是有益的，但在晚期，它只会令患者更加焦虑和疑神疑鬼，这不利于治疗，” 四川大学肿瘤学研究员黃博彥（音）说。

Ms Huang said that practices are changing, due to the increased influence of “western culture” and medical ethics.

黄女士说，由于“西方文化”和医疗伦理的影响日益增强，具体做法在不断改变。

Chinese physicians tend to favour disclosure more than family members, and attitudes have not changed in the Zhang household. Zhang Yufang has discovered new lumps, which doctors said follow the spread of cancer to her lungs and bones.

与家庭成员相比，中国的医生更倾向于向患者说明病情，不过，张玉芳家属的态度没有改变。张玉芳身上发现了新的肿块；医生说，这是由于癌细胞扩散到她的肺部和骨骼所致。

But her family told her they were harmless nodules, with her daughter asking her rhetorically: “If you really had cancer, how could you have survived so long?”

但她的家人告诉她，那些肿块是良性的结节。她的女儿还反问她说，“如果你真的得了癌症，你怎么能活这么久？”