Breaking bad news in oncology: like a walk in the twilight?

editorial Breaking bad news in oncology: like a walk in the twilight? While communicating good news is a pleasurable experience in our everyday lives, professional or private, communicating bad news is an uncomfortable experience for both the giver and the receiver. The expression 'bad news', used to describe difficult communications, is open to interpretation and misunderstanding since it seems to refer to a one off communication instead of a process and because it evokes the idea of an impersonal transmission of information. Bad news is defined as any information that produces a negative alteration to a person's expectations about their present and future [1]. Sigmund Freud often quoted the evangelic saying 'the truth will set you free, without truth there can be no freedom'. However, the truth regarding bad news can be dangerous because it deals with the essence of life. Does one give all the details of a clinical case or explain most of the case while holding back some details or be vague while at the same time not hiding the seriousness of the illness? Each of these approaches can reveal the truth; each can represent the way, the form and the opportunity to communicate bad news. There are, however, many variables to be taken into account such as the clinical situation, the gravity of the illness, the possibility of a cure, the prognosis, life expectancy and the patient's capacity to understand and sustain a conversation of this kind with his or her doctor. And the doctor? Is he or she aware that in our finite condition it is not always possible to have an absolutely truthful exchange, that it is not always possible to tell everything? Absolute honesty is probably not even part of our relative, imperfect and unfinished human condition and it would therefore be a mistake to think that we can see and make others see everything clearly. However, a doctor must at least try to say everything that can be said given the circumstances and so this becomes our everything. Many cancer patients see themselves as damaged, irreversibly traumatized, however their reactions differ greatly. Some have an absolute need to know the truth, even a terrible truth, about their state of health. They need to know the truth in order to fight and to live. Not knowing the truth or living in doubt even when done with the best intentions, leaves these patients in …