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.