Significant advances in cancer control and prevention have emerged from the front lines of medicine since the 1970s. Sophisticated diagnostic modalities aid in the timely detection of the disease. The benefits of established treatments such as chemotherapy and radiation therapy have been maximized gradually but steadily, and the risks have been minimized. Major changes in other aspects of cancer care have followed. For example, oncology personnel today pay far more attention than did their predecessors to issues such as the frank disclosure of diagnoses and treatment options, long-term quality of life for cancer patients and their families, and ethically complex scenarios that range from gaining consent from incompetent adults to the participation of children in discussions and decision making about cancer clinical trials.
These and other developments also have created new problems and concerns for clinicians, ethicists, and other stakeholders in the struggle against cancer. These issues include complicated questions about the nature, quality, and outcomes of oncologist-patient communication and decision making. Is there a preferred way for an oncologist to disclose a diagnosis of cancer to patients and their families that is frank and compassionate, truthful and hopeful? Should children diagnosed with cancer participate in discussions and critical decisions about their disease and its treatment? Can one envisage a continued role for paternalism in contemporary cancer care, and how effective or realistic are the models proposed as alternatives? Are oncologists responding to the growing ethnic diversity of their patients? What sorts of opportunities and obstacles will confront oncologists as people with cancer organize and inform themselves through online advocacy groups, websites that promote "alternative" treatments, and other high-technology resources?
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