該不該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歲時被診斷患上了肺癌，她於去年死於這種疾病。不過，一直到去世，她也不知道自己得的是什麼病，因爲她的家人把診斷結果向她隱瞞了兩年。

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

“我們只告訴她說，她得的是風溼病，”她的丈夫許聖訓（音）說。

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.

向癌症患者隱瞞診斷結果以免他們擔憂，在中國是常見的做法。但是，隨着中國的癌症負擔逐年增加——2015年確診病例達到430萬，是2000年的兩倍，而且超過其他任何國家——一些醫生開始反思這種做法，理由是隱瞞病情影響了治療。

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.

導致癌症病例上升的因素包括人口老齡化，以及吸菸等生活方式因素的普遍性，後者意味着肺癌和胃癌最爲常見。

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.

去年發表的研究結果顯示，在中國中部的河南省進行的研究發現，58%的食道癌患者沒有被告知診斷結果。其他研究結果顯示，這一比例在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.”

根據最近一項對中國醫生的調查，醫生往往會在患者不在場的情況下先向家屬披露癌症診斷結果。一位資深的腫瘤專家告訴研究人員，“在中國，看醫生就像是一次家庭成員的集會。家庭在治療過程中確實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.

親屬表示，隱瞞診斷結果的理由是，他們認爲診斷結果引發的擔心可能會使患者的病情惡化，或者他們負擔不起充分治療的費用。

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”.

欺騙患者可能頗費周折。2009年，84歲張玉芳（音）被確診患有甲狀腺癌。她的女兒張美清（音）請朋友僞造了一份“良性腫瘤”的診斷書。

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.

在一次摘除腫瘤的手術沒有取得預期效果後，家屬拒絕了化療，因爲他們認爲“一進入治療室，她就會意識到自己患了癌症，”張美清說。

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.

在發生一系列心懷不滿的患者和家屬襲擊醫生的事件後，中國的醫生也擔心自己因爲診斷引發的負面反應而被追究責任。儘管研究表明，超過70%的患者希望被告知診斷結果。

“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，你必須立即向病人告知基本診斷結果，但中國的做法不一樣。我們正在努力改進，”北京某醫院的腸胃科主任江波（音）說。“如果患者可以選擇自己的治療方案，治療效果會更好，我們可以從西方的資料看到這一點。”

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.

去年的一項研究結果支持了江波的觀點。研究顯示，被告知診斷結果的大多數中國肺癌患者並沒有出現或加重焦慮或抑鬱。

“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.

“（對病人隱瞞病情）在早期階段可能是有益的，但在晚期，它只會令患者更加焦慮和疑神疑鬼，這不利於治療，” 四川大學腫瘤學研究員黃博彥（音）說。

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

黃女士說，由於“西方文化”和醫療倫理的影響日益增強，具體做法在不斷改變。

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.

與家庭成員相比，中國的醫生更傾向於向患者說明病情，不過，張玉芳家屬的態度沒有改變。張玉芳身上發現了新的腫塊；醫生說，這是由於癌細胞擴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?”

但她的家人告訴她，那些腫塊是良性的結節。她的女兒還反問她說，“如果你真的得了癌症，你怎麼能活這麼久？”