WEDNESDAY, Dec. 19 (HealthDay News) -- Most cancer specialists do not respond to the emotional concerns of their patients with verbal expressions of empathy and support, a new study reveals.

The finding suggests that cancer patients' quality of life might be significantly improved if doctors were better trained to recognize and address patients' emotional concerns as they battle the disease.

"We audio-recorded doctor-patient interactions, and we analyzed them, and what we found is that when patients expressed negative emotions, doctors did not always respond empathetically," said study author Kathryn L. Pollak, an associate professor at Duke University Medical Center's Community and Family Medicine Department, in Durham, N.C.

Pollak's team published its findings in the Dec. 20 issue of the Journal of Clinical Oncology.

To assess the frequency of empathetic interactions in an oncology setting, the authors first surveyed 51 oncologists who were caring for a total of 270 cancer patients at Duke, the Durham Veterans Affairs Medical Center, or the University of Pittsburgh.

The physicians, mostly white and male, were questioned about their level of confidence in addressing patient concerns; their sense of how various communication approaches might affect a patient; and their general comfort level with psycho-social types of conversation.

As well, the doctors were asked if they felt they were more inclined toward the technological and scientific aspects of patient care or more disposed to focus on the social and emotional side of treatment.

The researchers also recorded almost 400 audiotapes of conversations that had taken place between physicians and patients.

All the patients had advanced-stage cancer, and their physicians indicated that they would not be surprised if they ended up dying from their illness within a year. Almost three-quarters of the patients were white, and they averaged a little over 60 years of age.

Most of the patients had established a relationship with their oncologist -- 90 percent said they had known their doctor for at least six months prior to the study.

According to the researchers, more than two-thirds of the physicians said they were oriented toward the technical aspects of patient care, but most were also highly confident in their ability to deal with patient concerns. Most of the doctors also believed they were comfortable with emotionally charged conversations.

Yet, after reviewing all the tapes, Pollak and her colleagues determined that cases in which doctors responded to patients' concerns with empathy were rare.

Fewer than 300 so-called "empathic opportunities" occurred during the almost 400 conversations. Such opportunities were defined as points at which a patient had verbally expressed negative emotions -- such as fear or worry -- to which the doctor could respond as he or she saw fit.

Female patients were more likely to express such feelings, particularly if their doctor was also female, the researchers observed.

When such emotions were expressed, almost three-quarters of the time, doctors chose to "terminate" the conversation by offering, for example, blanket reassurance that time would solve the problem.

Occasions in which doctors would empathetically promote "continuation" of the conversation by encouraging elaboration and/or expressing some form of understanding or support were far less frequent, occurring little more than a quarter of the time.

Oncologists who offered more empathic statements were younger than those who didn't, and those who stayed longer to converse with the distressed patient were more likely to have described themselves as highly focused on the emotional dimension of patient care.

The research team concluded that oncologists need better education to recognize and respond appropriately to patients' emotions.

"Oncologists clearly care about their patients," said Pollak. "They wouldn't go into oncology if they didn't. But oncology is a really challenging field, and, in general, oncologists have not been trained in how to communicate with patients. So, it's a pretty difficult situation for them."

"The good news is that the ability to communicate is something that can be taught," she added. "I wouldn't say it's an innate skill. Many doctors who say they are less comfortable conveying emotions with patients suffer from a lack of training. What they need is to be taught how to verbalize how they feel, and there have been several programs around the world that have shown that this kind of communication training can produce good communicators."

Pollak noted that she and her team are now conducting a follow-up study to see how communication skills might improve if oncologists were given personalized CD-Roms to screen video of their own interactions with patient. Data from the study has yet to be analyzed.

Another expert agreed that training could only help.

"The emphasis in medical school is not usually focused on the emotional side of things," noted Kevin Ochsner, an assistant professor of psychology at Columbia University, New York City. "It's about being able to get the diagnosis right. But, in fact, it's as important to communicate that a patient's feelings matter and are an important part of the equation as it is to convey the probability that a certain procedure will or will not have a positive outcome."

"Empathy," added Ochsner, "is the social glue that knits people together because the ability to connect with one another emotionally and to understand the feelings of one another promotes rapport and bonding. So, making patients feel that they're heard will help them feel secure and less anxious. It helps regulate their emotions, and this has all kinds of important mental and physical health effects."

More information

For more on physician empathy, visit the American Medical Association  .

MONDAY, Dec. 17 (HealthDay News) -- Something as common and available as sunlight may help prevent some lung cancers, researchers say.

A new study finds that lower levels of the sun's ultraviolet B (UVB) rays are associated with a higher incidence of lung cancer across 111 countries.

Still, that doesn't mean that spending more time in the sun will ever offset the risks that come with smoking, according to the study, which is published in the January issue of the Journal of Epidemiology and Community Health.

It's also not an excuse to trade skin cancer for lung cancer.

"The problem is that people might over-interpret this and stay in the sun for hours," said Cedric Garland, study senior author, professor of family and preventive medicine at the University of California, San Diego (UCSD), and participating member at the Moores UCSD Cancer Center in La Jolla.

Too little sun isn't great either, however, since sunlight helps the skin manufacture healthy vitamin D. "It would be false prudence to stay out of the sun to prevent skin cancer and not get enough vitamin D," Garland said.

Other experts, however, feel the focus should stay on cigarette smoking as the number one cause of lung cancer.

"When you have such a strong factor as tobacco, it really weighs out all these other small influences," said Dr. Jay Brooks, chairman of hematology/oncology at the Ochsner Health System in Baton Rouge, La. "It's a very interesting observation, but the main message is tobacco is such a strong influence in the development of lung cancer that we should concentrate on that."

More than one million people die of lung cancer worldwide each year. Cigarette smoking causes about 85 percent of lung cancers. The remaining cases are caused by exposure to secondhand smoke and a variety of other (some unknown) factors.

Sunshine is a significant source of vitamin D, as the sun's UV rays trigger synthesis of vitamin D in the skin.

Previous research, much of it by the same group, has found a strong association between breast cancer, colon cancer and other internal-organ cancers and living in latitudes with less sunlight. For example, one paper observed double the death rate from colon cancer above the U.S. Mason-Dixon line as below, leading the researchers to focus on lack of sunlight as the culprit.

It wasn't a new idea. "There were people in epidemiology dating back to Hippocrates who thought it was a good idea to live on the south side of a hill," Garland said.

Another study linked lower levels of a vitamin D metabolite in the blood with a higher level of colon cancer.

For this study, Garland and his colleagues looked at the association between latitude and exposure to UVB light and rates of lung cancer in 111 countries. Data came from an extensive United Nations database.

Although smoking showed the strongest association with lung cancer, exposure to UVB light also had an impact.

UVB light is greatest closer to the equator. This study showed that lung cancer rates were highest in regions farthest away from the equator and lowest in those regions nearest to it.

Higher cloud cover and aerosol use (both of which absorb UVB rays) were linked with higher rates of lung cancer.

For men, smoking was associated with higher rates of lung cancer, while greater exposure to sunlight was associated with lower rates.

For women, cigarette smoking, along with total cloud cover and aerosol levels, were associated with higher rates of lung cancer, while sunlight was again associated with lower rates.

Previous research has indicated that vitamin D may be able to stop the growth of malignant tumors.

"Everyone should be taking vitamin D, and, at all latitudes, there's plenty of potential to make vitamin D," Garland said. "Even in Helsinki, people can take advantage of the sun in summer months."

And vitamin D produced in the summer will carry over into the winter. Even so, unless you know what your vitamin D levels are, it might be wise to take a supplement, Garland advised.

More information

For more on vitamin D, head to the U.S. National Institutes of Health.

MONDAY, Dec. 17 (HealthDay News) -- Even if they're very small (1 centimeter or less), certain kinds of breast cancer tumors can still be aggressive and require maximum therapy, U.S. researchers say.

A team at the Mayo Clinic in Jacksonville, Fla., found that outcomes for women with HER2 positive (HER2+) and triple negative (HER2- and ER/PR-) tumors that have not spread to the lymph nodes may not depend on tumor size alone.

About 15 percent to 20 percent of breast cancers are HER2+, and about 10 percent to 15 percent are triple negative.

"This is a small study, and so we can't make treatment recommendations from it, but it appears that biology and not only size matters when it comes to selecting therapy for small, invasive tumors," lead researcher Dr. Surabhi Amar, a fellow in hematology/oncology, said in a prepared statement.

Amar noted there are no definitive treatment guidelines for breast cancer tumors less than one centimeter in size, because most studies include women with larger tumors or with breast cancer that's spread to the lymph nodes.

"We just don't have extensive data on tumors this small, so treatment becomes a matter of physician discretion," Amar said.

The study included 401 breast cancer patients: 350 with HER2 negative/ER/PR+ tumors; 27 with HER2+ tumors; and 24 with triple negative tumors. The women were followed for an average of about three years.

The researchers found that women with HER2+ and triple negative cancers were more likely (92 percent and 91 percent, respectively) to have grade 2 and 3 tumors than women with HER2 negative/ER/PR+ cancer (36 percent). Tumors are graded from 1 to 3. Higher grade tumors are more likely to grow faster and be difficult to treat.

The study also found that cancer recurrence was more common in women with HER2+ tumors (7.4 percent) and triple negative tumors (12.5 percent) than in women with HER2 negative/ER/PR+ tumors (1.3 percent).

The overall outcome for all the women with these small, lymph-node-negative tumors was excellent -- overall survival was 97.4 percent and disease-free survival 95.1 percent. One of the 24 patients with triple negative cancer died, none of the 24 women with HER2+ died, and one of the 219 women with HER2 negative/ER/PR+ cancer died.

The study findings suggest that women with small HER2+ and triple negative breast tumors should receive as much treatment as possible in order to prevent cancer relapse, Amar said.

But that doesn't appear to be happening. The study found that only 35 percent of women with triple negative cancers and 28 percent of those with HER2+ tumors received adjuvant chemotherapy (chemotherapy after surgery).

The study was to be presented Dec. 16 at the San Antonio Breast Cancer Symposium.

More information

The American Cancer Society has more about breast cancer  .

TUESDAY, Dec. 11 (HealthDay News) -- Men with a variant in the tumor suppressor gene DAB2IP may have an increased risk of aggressive prostate cancer, say researchers who examined genetic clues in Swedish and American men with and without the disease.

The researchers identified a single nucleotide polymorphism (SNP) -- a single base change in DNA -- located in the DAB2IP gene that was associated with aggressive prostate cancer in European and African-American men.

"Our study is among the first to report the presence of a potentially important prostate cancer aggressiveness locus. However, we cannot rule out the possibility of false-positive association. This report is intended to stimulate the conduct of additional confirmation studies for a gene that has strong statistical support and biologic relevance as a tumor suppressor gene," wrote Dr. Jianfeng Xu, of Wake Forest University School of Medicine in Winston-Salem, N.C., and colleagues.

The study was published online Dec. 11 in the Journal of the National Cancer Institute.

Previous studies have offered evidence that genetics play a role in prostate cancer. This has led researchers to suspect there are genetic variants that put some men at increased risk for the disease.

More information

The American Cancer Society details prostate cancer risk factors  .