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Both my direct and indirect experience with cancer is, admittedly, limited. So what follows may be seen as naive or misinformed. What I do know is that it both accurate and heartfelt.
Here's the background: my mother, a non-smoker, was diagnosed with lung cancer 5 years ago at age 96. She had the small tumor removed (VATS made it feasible) and recovered better and faster than anyone could have expected.
Last July, a PET scan revealed the cancer had spread in the original lung and had spread to the other lung. Do the math - at the time she was 101 years old.
The oncologist posed the possibility of treatment in the form of a pill (Tarceva). This took me by surprise, because I was thinking of the Big 3: surgery, chemo, and radiation. It turns out, of course, that
Tarceva is, essentially, chemo in a pill. At no point in the initial consultation did the word "chemotherapy" enter the conversation, and the side effects were downplayed.
We waited for two weeks while tests were run. It turned out that mom wasn't a good candidate for Tarceva (the analysis of the tumor that was removed when she was 96 revealed she didn't have the proper genetic markers). We also learned after doing a modest amount of research that the drug was contraindicated for patients with some of her medical conditions (possibly fatal gastrointestinal
perforation was just one of the side effects).
When mom's oncologist told me she wasn't eligible for Tarceva, he said that he consulted with some of his colleagues and that a form of traditional chemo might be possible. Just as with the Tarceva, I did some research and forwarded my findings and the doctor's comments to mom. She said "I'll let nature take its course," and died peacefully three months later.
Here's my first issue with the this experience. At no point, either in the initial, in-office consultation or subsequent phone calls, did we get a list of pros and cons of either treatment. That task, and the discussion with my mother, fell to me. I was the one who had to tell her about nausea, hair loss, and the multitude of side effects that would extend her life by a few months while at the same time dramatically decreasing the quality of that extra life. I told mom that I'd support any descision she made, but she had to be able to make an informed decision. And then I was put in the position of having to truthfully answer her simple question: "if you were me, what would you do?"
I love her and I'd do anything for her, but having to fill in the blank spaces left by the oncologist
is getting beyond my "job description" as a son. The explanation should be done by the doctor and the support of the treatment decision should fall to the family.
My other issue is even more fundamental than the first. Knowing how stressful the treatment would likely be, why on earth would anyone recommend any treatment to a woman, however strong, who
was born when Taft was president? Is there no recognition or professional training that allows the doctor to say "if I were you, I'd celebrate a good, long-lived life and let nature take its course"?
Or is nature always the combatant, to be dealt with at any cost at any age?
If I - 40 years younger - were in the same position, it'd be an entirely different story. I'd deal with the nausea and the other side effects. You could radiate me till I glow. It's an entirely different
phase of the life cycle. But again, when the patient has led an amazingly long and happy life, not suggesting that it end naturally and without battle scars seems ill-considered at best and callous
at worst. Non-treatment should be one of the "treatment" options posed by the doctor.
I realize oncologists, like all doctors, are trained to fight disease. I just wish that my mother's treatment at the end of her life would have included more informed, thoughtful, and balanced care.
You might have asked for what you wanted. Doctors are only human. I would have said, "My mother needs to know the following things so that we can make amore informed decision.......".
Both my direct and indirect experience with cancer is, admittedly, limited. So what follows may be seen as naive or misinformed. What I do know is that it both accurate and heartfelt.
Here's the background: my mother, a non-smoker, was diagnosed with lung cancer 5 years ago at age 96. She had the small tumor removed (VATS made it feasible) and recovered better and faster than anyone could have expected.
Last July, a PET scan revealed the cancer had spread in the original lung and had spread to the other lung. Do the math - at the time she was 101 years old.
The oncologist posed the possibility of treatment in the form of a pill (Tarceva). This took me by surprise, because I was thinking of the Big 3: surgery, chemo, and radiation. It turns out, of course, that
Tarceva is, essentially, chemo in a pill. At no point in the initial consultation did the word "chemotherapy" enter the conversation, and the side effects were downplayed.
We waited for two weeks while tests were run. It turned out that mom wasn't a good candidate for Tarceva (the analysis of the tumor that was removed when she was 96 revealed she didn't have the proper genetic markers). We also learned after doing a modest amount of research that the drug was contraindicated for patients with some of her medical conditions (possibly fatal gastrointestinal
perforation was just one of the side effects).
When mom's oncologist told me she wasn't eligible for Tarceva, he said that he consulted with some of his colleagues and that a form of traditional chemo might be possible. Just as with the Tarceva, I did some research and forwarded my findings and the doctor's comments to mom. She said "I'll let nature take its course," and died peacefully three months later.
Here's my first issue with the this experience. At no point, either in the initial, in-office consultation or subsequent phone calls, did we get a list of pros and cons of either treatment. That task, and the discussion with my mother, fell to me. I was the one who had to tell her about nausea, hair loss, and the multitude of side effects that would extend her life by a few months while at the same time dramatically decreasing the quality of that extra life. I told mom that I'd support any descision she made, but she had to be able to make an informed decision. And then I was put in the position of having to truthfully answer her simple question: "if you were me, what would you do?"
I love her and I'd do anything for her, but having to fill in the blank spaces left by the oncologist
is getting beyond my "job description" as a son. The explanation should be done by the doctor and the support of the treatment decision should fall to the family.
My other issue is even more fundamental than the first. Knowing how stressful the treatment would likely be, why on earth would anyone recommend any treatment to a woman, however strong, who
was born when Taft was president? Is there no recognition or professional training that allows the doctor to say "if I were you, I'd celebrate a good, long-lived life and let nature take its course"?
Or is nature always the combatant, to be dealt with at any cost at any age?
If I - 40 years younger - were in the same position, it'd be an entirely different story. I'd deal with the nausea and the other side effects. You could radiate me till I glow. It's an entirely different
phase of the life cycle. But again, when the patient has led an amazingly long and happy life, not suggesting that it end naturally and without battle scars seems ill-considered at best and callous
at worst. Non-treatment should be one of the "treatment" options posed by the doctor.
I realize oncologists, like all doctors, are trained to fight disease. I just wish that my mother's treatment at the end of her life would have included more informed, thoughtful, and balanced care.
I am not an expert but I see 2 reasons for the oncoogists actions: 1-at the age you mom is, I think having the family try and explain things to her is better than a doctore trying to, or I am guessing that is how the doctor felt and 2-even talking about treatments, is what they have to do to protect their you know whats.
That being said, I would never have wanted to see my mom, at over 100 go through anything treatments. There comes a time when we have to accept what is ahead.
Best luck to you and her..We ran into a similar situation but not the same with my mother in law about 10 years ago. At 97 she fell and broke her hip. Until that time she was relatively active but in a wheelchair because of an ankle that had never healed. Her mind was relatively sharp. When the doctor suggested hip surgery, hubby asked about the choices. Well, of course we were told without the surgery she would die. Hubby consented; what happened? She came through the surgery with flying colors, but had lost all will to live and died just about a month later. To this day we regret putting her through the surgery..
Unfortunately, far too often oncologists (and other medical professionals) don't know how to deliver bad news. I have meet medical professionals on my cancer journey who were phenomenal, warm, caring, and took time to explain things to me. Others have been horrendous. The doctor who sent me to get an emergency CT by myself when I showed up at the doctor's thinking I had an infection called me with my results that night and informed me that "It is probably life threatening and if you get x, y, z symptoms, go to the ER." All of the symptoms were those of the panic attack I was about to have. This was information I needed to know, but there are better ways of telling ANYONE that. And in my case, my doctor knew I had just moved across the country to start my first job and that I was sitting alone in an apartment to mull over the news.
You really need to be comfortable to ask questions - ask what the side effects are, ask what the prognosis is, etc etc. Some doctors are great about laying everything out for you, others aren't. My oncologist sent me to a fertility specialist as my 2nd appointment after diagnosis even before I asked while other friends had no idea that chemo would damage their fertility and now it's too late.
Most of us are raised to see doctors as monoliths of knowledge, even though we logically know that they are human. It becomes much harder in the office to know what questions to ask, how to ask, how far too push, etc - you are stressed, anxious, and not able to process the magnitude of what you are dealing with. I really encourage other caregivers and patients to come in with a list of questions to ask your oncologist. I asked really simple things that I knew the answer to if only to hear it out of my doctor's mouth and get comfortable to ask the big questions.
I am so sorry that your family had to go through this and I wish you peace in knowing that you did the best that you could.
That's what oncologists do -- they recommend treatment.
We just went through this with my MIL. While a lot younger (75), she has Parkinson's and is very frail. She had a malignant melanoma on her face, which was removed surgically and then grafted. But DH and I were discussing the options prior to the surgical option became the clear path -- would chemo or radiation be a wise choice for her? I asked DH if oncologists go through the side-effects and risks of treatment throughout, so patients can weight quality of life issues. He (an ER doc) said he hopes so. Not much reassurance there.
Go over to the caregiver forum. Some of us who actually have cancer aren't going to be very sympathetic to a poster complaining about the professionals that are fighting to save our lives.
I agree with the OP 100%. A woman who has been diagnosed with a second round of cancer at age 101 should be given reasonable outcomes for all treatments, and the option of letting NATURE take it's course.
I applaud the OP for having the courage to speak out about this disgrace.
I love her and I'd do anything for her, but having to fill in the blank spaces left by the oncologist
is getting beyond my "job description" as a son. The explanation should be done by the doctor and the support of the treatment decision should fall to the family.
My other issue is even more fundamental than the first. Knowing how stressful the treatment would likely be, why on earth would anyone recommend any treatment to a woman, however strong, who
was born when Taft was president?
I'm a doctor (primary care), and I agree with what you said. The doctor should explain the treatment (although if the patient is unlikely to understand it, the explanation would probably go to their family members). Especially for chemo or anything that will more than likely change quality of life. Sometimes we just get in a routine and forget that maybe we didn't explain that one thing that we usually do explain. In this day and age, I think doctors are not surprised by questions, so one should ask questions if they feel they are in the dark. Secondly, deciding NOT to treat is probably one of the harder decisions in medicine. I would think that a 100 year old person wouldn't be too hard to decide about....but you never know. Oncologists spend their days fighting cancer valiantly, I'm not surprised that sometimes they attempt to heal their patients who are really not redeemable. From my experience in ICU, it can often be hard to convince patient's families that it's time to let grandma go. For every person who might have preferred to abstain from treatment, there are 20 who would be disheartened, insulted and frightened if their oncologist said "let's just send you to hospice without trying anything".
I agree with the OP 100%. A woman who has been diagnosed with a second round of cancer at age 101 should be given reasonable outcomes for all treatments, and the option of letting NATURE take it's course.
I applaud the OP for having the courage to speak out about this disgrace.
If the doctor would have suggested hospice and a "nope we can't do anything for you" the family would have objected. When it is a family member that they are treating, it is a fine line to dance for doctors. They want to fix, they dedicate their lives to that end. The end of life decision is never an easy one to make, it is never easy for the family or doctors to make. Is the doctor a disgrace? I don't totally think so. Should he have mentioned other options? It would have been reasonable and prudent.
The below post explains it very well. Doctors are driven to heal, oncologist even more so.
Quote:
Originally Posted by 55degrees
I'm a doctor (primary care), and I agree with what you said. The doctor should explain the treatment (although if the patient is unlikely to understand it, the explanation would probably go to their family members). Especially for chemo or anything that will more than likely change quality of life. Sometimes we just get in a routine and forget that maybe we didn't explain that one thing that we usually do explain. In this day and age, I think doctors are not surprised by questions, so one should ask questions if they feel they are in the dark. Secondly, deciding NOT to treat is probably one of the harder decisions in medicine. I would think that a 100 year old person wouldn't be too hard to decide about....but you never know. Oncologists spend their days fighting cancer valiantly, I'm not surprised that sometimes they attempt to heal their patients who are really not redeemable. From my experience in ICU, it can often be hard to convince patient's families that it's time to let grandma go. For every person who might have preferred to abstain from treatment, there are 20 who would be disheartened, insulted and frightened if their oncologist said "let's just send you to hospice without trying anything".
I'm a doctor (primary care), and I agree with what you said. The doctor should explain the treatment (although if the patient is unlikely to understand it, the explanation would probably go to their family members). Especially for chemo or anything that will more than likely change quality of life. Sometimes we just get in a routine and forget that maybe we didn't explain that one thing that we usually do explain. In this day and age, I think doctors are not surprised by questions, so one should ask questions if they feel they are in the dark. Secondly, deciding NOT to treat is probably one of the harder decisions in medicine. I would think that a 100 year old person wouldn't be too hard to decide about....but you never know. Oncologists spend their days fighting cancer valiantly, I'm not surprised that sometimes they attempt to heal their patients who are really not redeemable. From my experience in ICU, it can often be hard to convince patient's families that it's time to let grandma go. For every person who might have preferred to abstain from treatment, there are 20 who would be disheartened, insulted and frightened if their oncologist said "let's just send you to hospice without trying anything".
I don't know if this thinking is the result of medical "training" (i.e., programming) or attitudes of popular culture, but with reference to the bolded comments:
1) The Hyppocratic Oath should actually be followed in every case, and in many cases "doing no harm" would mean doing nothing.
2a) "Fighting cancer" is misguided . . .it's "us versus them," dualistic, cowboy mentality thinking.
2b) DOCTORS don't "heal" anyone . . . to think otherwise is to delude yourself that you truly are gods . . .when really you are healthcare practitioners . . . and in best case scenarios, you would treat people as whole beings, not body parts in need of repair.
Illness stems from emotional, spiritual and environmental causes . . . Western medicine only treats symptoms and rarely even questions root causes.
Last edited by imcurious; 01-04-2013 at 09:09 PM..
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