Commentary: Disclosure in oncology -- to whom does the truth belong?

The term "therapeutic nondisclosure" refers to a clinician's decision to withhold diagnostic or prognostic information from a patient to protect him or her from perceived harm. We present a vignette in which the son of a 75-year-old Italian born immigrant asks her physician to withhold her new diagnosis of advanced myeloma. In the U.S., trends over the last 30 years have been toward more complete disclosure of cancer-related information. This can be attributed to the evolution of research subject protections, the "war on cancer," the civil rights and patient rights movements, and the rise of hospice and palliative care. In other parts of the world, however, therapeutic nondisclosure is still commonly practiced. Here, we deconstruct and call into question current arguments for nondisclosure. We provide practical recommendations to the practicing clinician in the U.S. who wishes to approach a request for nondisclosure, and disclosure itself, in a compassionate and respectful way.