Cancer: Is it true that oncologists refuse to be treated for terminal cancer?
Cancer: Is it true that oncologists refuse to be treated for terminal cancer?
I have heard that many oncologists, knowing full well that treatment for terminal cancer is futile and excruciating, refuse it.
Is it true?
Is it true?
David Chan, MD from UCLA, Stanford Oncology Fellowship
I've had the misfortune of taking care of oncologists with advanced cancer and they are not much different than other patients in their desire to live longer. From my perspective, quality of life is as important as quantity of life.
Not every advanced cancer is the same. Some patients can be very ill with widely metastatic cancer and expect meaningful remissions with chemotherapy. Breast cancer, ovarian cancer, colon cancer, some of the lymphomas, myeloma, and some subtypes of lung cancer are examples.
Some very advanced cancers in critically ill patients can even be cured with chemotherapy. Examples include some lymphomas, leukemias, and testicular cancer.
And then there are some advanced cancers that are very difficult to treat no matter what, even to get a short remission. Those include some lung cancer situations, and most sarcomas and cancers of the pancreas, gallbladder and bile ducts. For these patients, depending on age, other contributing illness, level of fitness and desire for treatment, often the best course of treatment can be to treat symptoms without trying to add chemotherapy. The oncologist may decide against chemotherapy taking into account low expectations of benefit and potential side effects.
I haven't found oncologists as patients to be particularly nihilistic when it comes to chemotherapy for terminal cancer. Just as some patients are more optimistic and others more pessimistic, so are physicians who face these difficult life choices.
People often wonder why someone would take chemotherapy for limited expected benefit. Sometimes this is dictated by life circumstances such as the impending wedding of a daughter, birth of a grandchild or graduation of a son. For these patients and their families, an extension of life by 4-6 months could be incredibly meaningful.
I've had circumstances where patients, critically ill and suffering greatly, have wanted to hang on for another month so that their spouse could benefit from a pension. (Last year I had more than a few patients express wishes to die early to avoid the expected increase in estate tax.)
Keep in mind that if a chemotherapy is tried and significant side effects occur, it can and should be stopped or significantly adjusted to make the treatment tolerable. Most modern chemotherapy can be given with mild side effects because of the excellent supportive medications now available to control nausea and reduce infections. Also many patients with advanced cancer are often already very ill from their disease. They can then reach a tipping point because of disease progression, not from taking chemotherapy (although the chemotherapy gets the blame).
Chemotherapy in advanced cancers situations should not make patients feel worse or shorten their lives. It's important for patients to have an oncologist experienced enough and with good clinical judgement to withhold treatment when it's appropriate.
I've had the misfortune of taking care of oncologists with advanced cancer and they are not much different than other patients in their desire to live longer. From my perspective, quality of life is as important as quantity of life.
Not every advanced cancer is the same. Some patients can be very ill with widely metastatic cancer and expect meaningful remissions with chemotherapy. Breast cancer, ovarian cancer, colon cancer, some of the lymphomas, myeloma, and some subtypes of lung cancer are examples.
Some very advanced cancers in critically ill patients can even be cured with chemotherapy. Examples include some lymphomas, leukemias, and testicular cancer.
And then there are some advanced cancers that are very difficult to treat no matter what, even to get a short remission. Those include some lung cancer situations, and most sarcomas and cancers of the pancreas, gallbladder and bile ducts. For these patients, depending on age, other contributing illness, level of fitness and desire for treatment, often the best course of treatment can be to treat symptoms without trying to add chemotherapy. The oncologist may decide against chemotherapy taking into account low expectations of benefit and potential side effects.
I haven't found oncologists as patients to be particularly nihilistic when it comes to chemotherapy for terminal cancer. Just as some patients are more optimistic and others more pessimistic, so are physicians who face these difficult life choices.
People often wonder why someone would take chemotherapy for limited expected benefit. Sometimes this is dictated by life circumstances such as the impending wedding of a daughter, birth of a grandchild or graduation of a son. For these patients and their families, an extension of life by 4-6 months could be incredibly meaningful.
I've had circumstances where patients, critically ill and suffering greatly, have wanted to hang on for another month so that their spouse could benefit from a pension. (Last year I had more than a few patients express wishes to die early to avoid the expected increase in estate tax.)
Keep in mind that if a chemotherapy is tried and significant side effects occur, it can and should be stopped or significantly adjusted to make the treatment tolerable. Most modern chemotherapy can be given with mild side effects because of the excellent supportive medications now available to control nausea and reduce infections. Also many patients with advanced cancer are often already very ill from their disease. They can then reach a tipping point because of disease progression, not from taking chemotherapy (although the chemotherapy gets the blame).
Chemotherapy in advanced cancers situations should not make patients feel worse or shorten their lives. It's important for patients to have an oncologist experienced enough and with good clinical judgement to withhold treatment when it's appropriate.
