Cancer care starts with hope and empathy. Panic at diagnosis is natural, but most cases allow time for reflection and second opinions. A strong doctor-patient bond and realistic goals matter most. Treatment should be personalised, not just protocol-driven. Especially in stage four, the focus must shift to quality of life and meaningful conversations—not just cure.

Shahid Akhter, Editor, Healthyouonline, spoke to Dr. Ang Peng Tiam, Medical Director and Senior Consultant, Medical Oncology at Parkway Cancer Centre, Singapore, to figure out how doctors and patients can set realistic goals in cancer care — ensuring that treatment enhances quality of life rather than merely prolonging it with unbearable toxicity.

Cancer care begins with HOPE

To the cancer patient, it is important never to lose hope and  live every day to its fullest. For the cancer doctor, it's important to respect his patients. To treat them as fellow human beings and offer them the best advice to improve their chances of beating this dreaded disease.

Cancer care: Switch off the panic button

To me, one of the mistakes that's often made is the panic that the patient feels when they are first diagnosed with cancer. It is this feeling that, oh, everything must be done immediately. I have no time to think about it. I have no time for a second opinion. Rarely is that the case. Indeed, there are situations where there is a need for urgent surgery, where you may not have an opportunity to seek a second opinion. However, in most cancers, it is often good to take time out to almost have a period of cooling off to think about the options that have been presented to hear different views in order to decide what is most suitable for your particular cancer.

So, step number one: Don't panic. Number two: It is important to have a good relationship with your doctor to be able to ask questions and have these questions answered. All too often the doctor is seen like a God. You know that he can make no mistakes. That is, that he's too high up for you to ask questions. It is important, as a doctor, to answer these questions so that the patient understands what is going on and cooperates with the management. With this, a strong understanding of the disease and a good relationship. That is the secret to a favourable outcome.

Cancer care: One size does not fit all

It is very important to assess each patient as the treatment goes on. It is important not to treat patients as digits but rather as individuals. Treatment often has to be tailored and adjusted based on the toxicity profile and dependent on the fitness of the patient. That's why it's important that the patient should be treated by a doctor who takes an interest in his or her well-being, rather than just following a protocol and delegating treatment.

Cancer care: MOTIVATION MATTERS

The goal must be something that is realistic. It is unrealistic for a patient to ask for a cure when indeed there is no cure that is possible. That is why it is important for the doctor, at a very early stage of interactions, to explain to the patient exactly what is going on. It is only through understanding and setting of common goals. Realistic goals that you can get the cooperation of the patient and the family.

It is important from the very beginning to be honest with the patient to establish what are the likely benefits, the toxicities of treatment, and what are the goals of management to treat a patient with a curable cancer and to treat a patient with a cancer that cannot be cured. It's different in a patient, but cure is the final objective.

We are often willing to accept a certain degree of toxicity because the outcome at the end of the day is really trying to cure the patient and prolong life to a ripe old age. However, in treating a patient with stage four cancer that is not curable, the goals are different. It is to control the disease, to preserve the quality of life, and to extend life.

Cancer care: Goals must be realistic

We should never treat a stage four patient to a point where toxicity becomes unbearable, whereby the patient finds that even though life can be extended, life is not worth living. That's why it's very important to have this conversation with the patient to understand the goals. And so that the treatment is not futile.