Communication can be defined as a voluntary and purposeful sharing of information between two or more participant in an attempt to convey or receive the included massage. Communication plays a vital role in the continuum of health care delivery system worldwide. Effective communication is the basic foundation and the priority pillar in the medical field due to its direct role in the safety, quality of the patient care, patient satisfaction and overall clinical outcome [1] . Communication between health care workers and the patients account for a major portion of the information flow in the health care sector and any error in this flow system results in substantial increase in morbidity & mortality [2] . In a retrospective study done in Australia on 16,000 in-hospital deaths, it was found that communication error was the leading cause of death & was twice as frequent as inadequate clinical skills [3] . A survey done on primary care physicians detected that around 50% of all detected adverse events were due to communication error or difficulties [4] . Thus, there is a need for optimization of the physician-patient communication dynamics. However, there are various challenges in good communication in different aspects of the clinical field. Some of the barrier against effective communication includes-language & cultural differences; stress, emotional response & psychiatric triggers from medically related conditions; lack of access to auxiliary aids; behavioral & physical barriers, etc. [1] . All these barriers challenge the good communication in clinical practice. Some of the key tasks in effective communication include―a) elicitation of patients condition, their perception & effect of the condition on both physically & emotionally, b) tailoring of information based on patients understanding, c) elicitation of patients reaction & their concerns, d) categorization & quantification of patients interest in decision making, e) effective discussion of treatment option & implication with the patients, f) maximizing patient compliance [5] .

In most of the cases, physicians lack these communication skills or they respond to various emotional cues with strategies that block further disclosure by the patients [5] . Also, patients may withhold information due to various beliefs including nothing can be done or do not want to burden the physician or look pathetic or from a fear of their disease status by the physician [5] . Thus, depending on the clinical scenarios, physio-mental condition of the patients and communication skills of the health care worker, various challenges are expressed and interpreted. One such communication challenges occur with cancer patients. This write up focuses on the challenges in communication in cancer patients.

Unlike patients with other medical conditions, the communication with cancer patients are unique due to the fact that there are certain level of uncertainties related to treatment, survival & cure, involvement of various treatment protocols & modalities, interaction of multiple clinicians & change in health care team over time [6] . All these results in various communication related challenges, which are included in Table 1.

All these challenges may play a vital role in the overall disease management and undermine the desired clinical outcome in cancer patients. Various studies looking at the effect of effective communication on good cancer care found that there are many drop outs in cancer care due to patients being unsatisfied or confused about the overall management plan, compliance & lack of confidence on the physicians [11] . Every year British National Health Service Ombudsman receives many complaints of which majority are due to communication failure [12] . A study done on 117 cancer patients found that most of the times patients had very few opportunities to ask important question or respond to information conveyed to them with minimal attention paid to patients psychosocial needs [13] . Various studies found that around 40% of the cancer patients wanted to be fully informed and be involved in decision-making process [14] . It has also been seen that a majority of the health care workers involved with cancer care are not adequately trained in communication skills. Although there are evidences of the significance of effective communication in medical practice, there is not much research or emphasis on communication skill development in cancer care. This paper will provide a brief overview of ways to overcome the communication challenges in cancer patients.

Effective communication between clinician & patients related to consultation may play an important role and predict health outcomes in cancer patients [15] . A review of various RCTs found that communication mostly affects health through various indirect pathways through proximal (satisfaction, trust, motivation, etc.) & intermediate outcomes (access to case, compliance, self-care, emotional management, etc.) as shown in Figure 1 [6] [16] [17] . Street et al. found seven pathways through which good communication might indirectly lead to better quality of health in cancer patients [15] . These include increased health care access, increased patient knowledge and understanding, higher quality of medical decisions, increased social support, enhanced compliance, patient empowerment and improved management of emotions.

Thus, any intervention done to maximize the therapeutic effect of communication and overcome the challenges in communication should focus on achieving these proximal & intermediate outcomes.

Encounter with cancer patients are very emotion-laden and requires a great deal of clinical & communication skill on part of the health care team. Management of communication challenge in cancer patient include―

Communication in cancer patients is a unique and challenging aspect, which strikes at the very foundation of clinical care, adherence and health outcome. These communications are embedded in multiple layers of the context that needs to be modulated so as to achieve a meaningful and proactive communication. Thus, there is a need to acknowledge the challenges and do further research to get an insight into the various underlying barriers to concordance in the patient-physician communication and design and implement various intervention protocols in cancer patients.

IrtizaHasan,TasnuvaRashid, (2016) Clinical Communication, Cancer Patients & Considerations to Minimize the Challenges. Journal of Cancer Therapy,07,107-113. doi: 10.4236/jct.2016.72012