Communication between doctors and patients is an integral part of the doctor-patient relationship. Within the first few encounters, the doctor is likely to have given the patient his diagnosis, the possible treatment options, the associated risks and the long-term outlook. With minor ailments, the amount of information given would be limited. Thus, even if the patient could not recall all the facts, the consequences of ‘forgetting’ these facts would not be crucial. However, if the patient has a serious illness such as cancer, the inability to retain some of the facts / information may lead to undue anxiety and psychological stress. How can we improve information retention by the patient?

Researchers from the University Hospital of Wales, UK, randomized a group of 58 patients, newly diagnosed with oesophageal or gastric cancer, to receive or not to receive an audiotape recording of the consultation when they were informed of the cancer diagnosis (Patient Educ Couns 2008; 72: 218 – 222). These patients were assessed for their ability to retain information given at the consultation and the psychological ill effects of the news. Patients randomized to receive tapes were significantly more likely to retain information than patients who were given the news and information only at consultation. Both controls and patients given tapes did not show any difference in their psychological state. The provision of taped consultation did not adversely affect psychological outcome. In another study from the University of Manitoba, Canada, 425 men newly diagnosed with prostate cancer (Psychooncology 2007; 16: 543 – 552) were randomly assigned to one of 4 consultation groups: (1) standard care control – no taping; (2) consultation audio-taped but no tape given; (3) consultation taped and an audiotape given to patient and (4) consultation audio-taped and patients offered the choice of receiving the tape or not [94 of 98 patients accepted the tape]. The study found that, compared to control patients, patients who received the audiotape reported having been provided with significantly more disease and treatment information in general, more information about treatment alternatives and treatment side-effects.

In situations where patients are told of a bad diagnosis such as cancer, their ability to retain all the relevant information on treatment options, side effects and risks is likely to be adversely affected. These patients are likely to be ‘shell-shocked’ and unable to hear anything beyond the words ‘you have cancer’. Providing an audiotape of the consultation is certainly one way of ensuring that the patient and relatives can replay the information given.

In the East, during consultation, the patient may be more comfortable conversing in a dialect or one language (Mandarin / Bahasa) with the doctor, while the children may be more comfortable conversing in English. Even among the children, some might  be more comfortable to have the information in Mandarin / Bahasa while others would like it in English. Thus, providing an audiotape of the consultation may not solve all information transmission and retention issues. In my practice, at the end of the consultation, I prefer to ask the patient to return in a few days with a family member so that we can go over the diagnosis and discuss the matter again. I also encourage the patient and the accompanying relative / friend to write down any questions that come to mind so that they can ask at the next consultation. Providing an audiotape is certainly an alternative but I do think it is not the same as a face to face discussion with ample time set aside by the doctor just for that purpose.

A long lost friend visited me with his daughter recently and over lunch he lamented that his children dislike vegetables - most probably because he has set a bad example by not liking vegetables and not eating any himself! How important are vegetables and fruits in our diet?

A recent study from the University of Hawaii investigated the association of vegetable, fruit and grain intakes with colorectal cancer risk in the Multiethnic Cohort Study (Am J Clin Nutr 2008; 88: 730 – 737). A total of 85,903 men and 105,108 women, living in Hawaii and Los Angeles County, California, completed a 26-page-long quantitative food-frequency questionnaire, over the period 1993 and 1996. The 5 ethnic groups studied were Afro-American, Japanese American, Latino, Native Hawaiian and Caucasian. They were then followed up for an average of 7.3 years. The median intake of vegetables and fruits combined was higher for Latinos and Native Hawaiians and lower for Afro-Americans, Japanese Americans and Caucasians. The risk of developing colorectal cancer in men who took the highest amount of vegetables and fruits was 26% lower than in those who consumed the least. If you only eat fruits but no vegetables, the risk reduction is only 20%. If you only eat vegetables but no fruits, then the risk reduction is 15%. When the analysis was performed for colon and rectal cancer separately in men, the associated risk reduction was stronger for colon than for rectal cancer. In women, the association between colorectal cancer risk and vegetable and fruit consumption was observed but this trend did not reach statistical significance.

In a separate publication, researchers from the University of Florence performed a meta-analysis of the effect of adherence to a Mediterranean diet on mortality and the incidence of chronic diseases [(BMJ 2008; 337: a1344); a free copy of the publication can be obtained at http://www.bmj.com/cgi/content/full/337/sep11_2/a1344] . The analysis was performed on 12 studies involving a total of 1,574,299 individuals. The analysis showed that greater adherence to a Mediterranean diet is associated with a significant reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), incidence of or mortality from cancer (6%) and incidence of Parkinson’s disease and Alzheimer’s disease (13%).

The key components of the Mediterranean diet include generous amounts of fruits and vegetables, consumption of healthy fats such as olive and canola oils, eating small portion of nuts, consuming little red meat but eating fish on a regular basis and, for some, drinking red wine in moderation. From these two recent studies it can be seen that vegetables and fruits are important for maintaining a healthy body and warding off diseases. If you have a family, start them off young with the habit of eating fruits and vegetables. If eating vegetables wasn’t your cup of tea while growing up, perhaps you should start for yours and your children’s sake.

Being overweight and obese [body mass index (BMI) > 25] has been shown to be associated with increased risk of colon cancer, especially among men. Even when you are not overweight / obese, will weight change in adulthood have an influence on your subsequent colon cancer risk?

Researchers from the Harvard School of Public Health examined this question by studying 46,349 men, aged 40 – 75, who were participating in the Health Professionals Follow-up Study (Int J Cancer 2008; 123: 1160 – 1165). All men were cancer free at baseline and were followed up for an 18 – year period, from 1986 to 2004. A cumulative mean BMI > 22.5 was found to be associated with an increased risk of colon cancer. A short term weight gain of 10 pounds (4.54 kg) in the prior 2 – 4 years was significantly associated with increased risk of colon cancer. For every 10 pounds gained, the risk is increased by 14%. The risk of colon cancer is increased by 33% for every 10 pounds of weight gained per 10 years since age 21.

The above study involved men only. What happens in women? Will weight loss affect cancer risk in women? A study from the University of Minnesota looked at the influence of voluntary weight loss on the incidence of cancer in post-menopausal women (Int J Obes Relat Metab Disord 2003; 27; 1447 – 1452). The research studied 21,707 women, cancer free at baseline, over the period 1993 to 2000. Compared to women who never had voluntary weight loss of ≥ 20 pounds during adulthood, the incidence rates for all obesity – related cancer was lowered by 14% in those women who had voluntary weight loss. For specific cancers, voluntary weight loss led to a 19%, 9% and 4% reduction in the incidence rate of breast, colon and endometrial cancers respectively.

Putting on weight is associated with increased cancer risk. In addition it is also associated with increased cardiovascular and metabolic health risks. I am sure that the intention of these and other studies on the ill effects of weight gain is certainly not to scare you away from enjoying your food. If you eat healthily, consume moderately, exercise and watch your weight, you can still enjoy your food without exposing yourself to the added risk of developing cancers, ischaemic heart disease and diabetes.