Why Does a Patient with Recurrent Breast Cancer Become Angry with Their Doctor?

An early-stage breast cancer patient is evaluated by a medical oncologist before or after surgery. Depending on risk, preventive treatments to reduce recurrence include chemotherapy, radiotherapy, targeted drugs and hormonal therapies.

From the initial diagnosis, difficult days begin for patients and families. They initially feel they have encountered the worst thing in the world, experiencing deep unhappiness, fear and anxiety . An expert breast cancer team manages this transition gently, plans how treatment can lead to recovery and explains it to patients and families. Understanding treatment and receiving hopeful, knowledgeable, caring guidance reassures people diagnosed early and restores confidence.

Before surgery (neoadjuvant) or afterward (adjuvant), chemotherapy usually lasts 4-5 months. Depending on risk and tumor characteristics, patients complete preventive radiotherapy and targeted treatment. If hormone-sensitive, the doctor recommends 5-10 years of oral hormonal therapy and tells them the difficult treatment course is over. A new frightening period begins here: saying goodbye to the reassuring oncology clinic and healthcare team that has almost become family. They return to life and try to stand on their own again. This new beginning creates a new anxiety for the recovered survivor: "what if my disease returns?" .

Particularly for high-risk patients, this also causes concern for the oncologist. Reassured that the best scientifically supported treatments were provided, the doctor explains matters again and tries to reduce present and future fears. Checks every 3-4 months are recommended, circumstances for contacting the clinic before the next appointment are explained, and remission/follow-up begins. Patients and families ask how often they will need CT, MRI or PET scans . The answer increases anxiety: "Unless necessary, we will not perform PET, CT, MR or tumor tests, because they do not help detect a cancer destined to recur early."

Patients regard these tests as valuable, thinking, "Would it not be better to perform them frequently and detect recurrence early?"

Even with the most appropriate scientifically proven treatments, recurrence cannot be prevented in some patients!

Just as riding in the best car with the most skilled driver who has never crashed does not eliminate accident risk, recurrence cannot be prevented in some early-stage breast cancer patients. An unfortunate patient seen every three or four months may contact their physician before or at an appointment with progressively worsening, persistent symptoms that do not subside, such as fatigue, weight loss, bone pain, cough, shortness of breathor abdominal pain, or headache, double vision, visual disturbance or altered consciousness. The physician orders blood and radiological tests. Ultrasound, PET or MRI may detect recurrence. Patients and families are saddened and may also feel anger or hurt toward the doctor, sometimes progressing to accusations.

To avoid this unwelcome situation, oncologists must take time at the end of preventive treatment to explain recurrence risk and how it may emerge, that frequent tests do not reduce it, and that unnecessary tests can mislead and cause needless biopsies.

In the 1970s, breast cancer recovery or cure rates were around 65%; today they exceed 90%. Despite this major improvement, some patients within the remaining 10% are initially diagnosed with metastasis , at stage four, while others are diagnosed early and recur during follow-up. Despite medical advances, no realistic test precisely identifies who will recur. Many effective, accessible treatments are also available for recurrent cancer. If recurrence involves multiple-organ metastases, cure or complete recovery is not expected. Treatment aims to reduce complaints, improve quality of life and prolong survival as much as possible.

If patients and families experiencing this situation have lost trust in their treating oncologist, they should seek a second opinion from another medical oncologist. Oncologists consulted should evaluate the distressed, hurt patient comprehensively. They should explain openly and honestly, addressing questions, and not speak negatively about the treating physician unless there is a clear error or negligence. The less confusing and accusatory the approach, the less patients and families will regret the past, and the easier subsequent care becomes for the patient, family and oncologist.

• Fear of cancer recurrence goes beyond depression and distress