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Knowing When to Bow Out Gracefully

Knowing When to Bow Out Gracefully

Here is a true story, one that you won't see on ER or Chicago
Hope--A 64-year-old man is referred to me with cancer that started
somewhere in his intestines and is now replacing liver and lung.
He is bed-bound, losing weight quickly, and has no appetite. He
has been treated with two types of chemotherapy, both of which
have made him sick, yet the cancer has continued to grow.

He and his family want to continue active treatment, but I have
no chemotherapy that has any chance of shrinking the cancer or
improving his health state. The patient and family refuse to talk
about "do not resuscitate" orders.

He says that his previous doctors told him his chemotherapy "had
a good chance of working," and he wants to continue therapy
that he believes gives him a chance of cure or long-term survival.

The doctors at the other cancer center never told the patient
that he had less than 6 months to live, and that survival for
his cancer had not improved for the past 20 years. They never
mentioned that the chemotherapy had no chance of cure, and had
never been proven to make people live longer or better despite
20 years' worth of trying. "We didn't bring it up, because
he didn't, and he seemed to want a hopeful approach," they
told me.

When Do You Quit?

Oncologists often fail to communicate to their patients what cancer
treatments can and cannot do, and to explain to them when it is
time to quit aggressive chemotherapy. That lack of communication
is the focus of this article.

A separate article addressed to patients appears on page 4, and
I would encourage you to make copies of that article for your
patients, to help them understand what they need to know about
their cancer and what questions they need to ask about their treatment.

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