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How Doctors Break Bad News May Impact Mesothelioma Survival

For newly diagnosed mesothelioma patients, having a doctor who is too compassionate could have a negative impact on their survival.

Researchers at France’s University of Lille made that seemingly counterintuitive observation as part of the first study of the prognostic role of physician empathy in cancer patients.

The results, published in the Journal of Clinical Medicine, suggest that, rather than comforting patients, too much compassion and listening from the oncologist tends to make them worry more about their odds of survival.

Physician Attitude and Mesothelioma Outcomes

The study involved 179 patients who were diagnosed with lung cancer or pleural mesothelioma between January 2015 and March 2016. Both cancers are difficult to treat and often carry a poor prognosis. This is especially true of malignant mesothelioma which is highly resistant to conventional cancer therapies.

Patients were asked to rate their oncologists’ empathy using a questionnaire that included two sub-dimensions: listening/compassion and active/positive empathy. Then their survival was tracked until April 2018. The median follow-up time was 3.1 years.

In their newly released report, the authors, including researchers in Cognitive and Affective Sciences, Epidemiology, and Thoracic Oncology, concluded that physician attitudes did have a bearing on mesothelioma survival but that it varied based on how emotionally charged the appointment was.

“There was a statistical interaction between listening/compassion empathy and type of consultation such that in bad news consultations, higher listening/compassion predicted a higher risk of death,” writes Sophie Lelorain. “In follow-up consultations, listening/compassion did not predict survival.”

The group found that perception of general empathy also resulted in shorter mesothelioma survival, but the same was not true of what the study called “active/positive empathy.”

Mesothelioma Patients Need to Feel Hopeful

How could physician attitude — completely apart from any mesothelioma treatment — impact patient survival? The researchers theorize that it has to do with patients’ need to feel hopeful about their prognosis.

“In bad news consultations, high patient-perceived physician compassion could worry patients by conveying the idea that there is no longer any hope, which could hasten death,” writes Lelorain.

The team is calling for further studies on physician empathy and cancer patient survival, including what determines how patients perceive their doctor’s attitude. 

Some of the longest-living mesothelioma survivors say positivity and hopefulness have helped them defy their prognosis and maintain their quality of life. Read more about attitude and lifestyle choices and their impact on mesothelioma survival in Surviving Mesothelioma and Other Cancers.


Lelorain, S, et al, “Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial”, October 17, 2018, Journal of Clinical Medicine

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