title: Exceptional patients and communication in cancer care-are we missing another survival factor?
abstract: There is increased awareness of the issue of exceptional survival beyond expectations among cancer patients with poor prognosis, and researchers are starting to look closely at this phenomenon. In this study, we explored the perceptions of these "exceptional patients" as to their understanding and insight into their unusual experience.
  
  
  
  We used a qualitative approach consisting of in-depth, open-ended interviews with exceptional patients in two locations, Texas and Israel, from 2007 to 2014. The interviews were audio-recorded and qualitatively analyzed, and gave rise to illness narratives entailing detailed descriptions of patients experience over the course of their disease and treatment. A qualitative content analysis focusing on contextual meaning was utilized.
  
  
  
  Twenty-nine patients participated in our study. The mean years since diagnosis was 9.55 years (range, 4-23 years). All patients had received conventional treatment, including surgery, chemotherapy, and radiation therapy. One of the prevailing themes in these interviews was related to the patient-doctor relationship. Most participants mentioned that the support they received from one or more physicians was a crucial factor for their exceptional survival.
  
  
  
  The significance of patient-doctor relationship in cancer survival requires further research. This research is especially important as it adds to the current trend of patient centered care and points to the added value of relationship between health providers and patients. This relationship, as perceived by these exceptional patients, can be a factor that adds to improved survival in cancer care.
authors.affiliation: The Integrative Medicine Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. frenkelm@netvision.net.il.|The Complementary and The Integrative Medicine Unit, The Institute of Oncology, Meir Medical Center, Kfar Saba, Israel. frenkelm@netvision.net.il.
authors.forename: Moshe
authors.initials: M
authors.lastname: Frenkel
authors.affiliation: School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Joan C
authors.initials: JC
authors.lastname: Engebretson
authors.affiliation: The Minerva Center for End-of-Life Studies, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Sky
authors.initials: S
authors.lastname: Gross
authors.affiliation: School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Noemi E
authors.initials: NE
authors.lastname: Peterson
authors.affiliation: David Yellin Academic College, Jerusalem, Israel.
authors.forename: Ariela Popper
authors.initials: AP
authors.lastname: Giveon
authors.affiliation: Department of Anesthesiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Sapire
authors.affiliation: Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University and Sharon-Shomron District, Clalit Health Services, Tel Aviv, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Hermoni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations / Q000941:ethics*
keywords: Cancer care; Cancer prognosis; Cancer survival; Exceptional patient; Exceptional physician; Patient-doctor communication; Remarkable recovery