Cancer is a crime, and how a tumor board is the courtroom

by Katherine O’Brien

Cancer patients usually say they want a cure. Well, of course, that goes without saying. But it’s also kind of annoying.

We’ve all, as children and adults, had those “What if” conversations. What if you could have anything you wanted in the whole world? Depending on the respondents’ ages, people might say anything from “a banana cream pie” to “a trip to Brugge.”

But inevitably some killjoy says something like “world peace” or “affordable public parking,” in a voice that manages to convey both noble martyrdom as well as a finger wagging rebuke: “Shame on you for being so materialistic.”

Don’t get me wrong. A cure is nothing to sneeze at. But what I really want is justice. I don’t mean the Gideon’s Trumpet-public-defenders-for-everyone justice. I mean the Jerry Orbach kind. Hey Dick Wolf, where is “Law & Order: Special Genome Unit” ?

Cancer is a crime. Don’t you feel robbed? Assaulted? Derailed on your pursuit of happiness? Well, who is responsible for this crime? Who did this to you? They must be punished! Justice must be served!

Most people, upon being diagnosed, cordon off their memories with yellow tape and start spraying mental Luminol everywhere. They sift through the evidence and pounce on any clue: “So, THAT’s what caused my cancer! It was Colonel Mustard in the library with the carcinogenic lead pipe! I knew it!

If only Jessica Fletcher worked in cancer research. “If you lived in Cabot Cove from 1984-1996, there was a pretty good chance that someone was going to murder your ass,” this writer observes. “With a body count of up to eight per episode, Cabot Cove experienced an outbreak of no less than 800 murders during the time that Jessica Fletcher lived there.”

And yet every single murder was SOLVED! No cold cases on Angela Lansbury’s watch.

The majority of cancer patients can’t trace their disease to one specific cause. Like “Murder on the Orient Express” it’s a complex crime and chances are excellent the criminal didn’t act alone.

Beyond cancer justice, I want cancer exoneration. People tell you all the time, “It’s not your fault you got sick.” But then they want you to reform yourself into an Augustinian-like ascetic. Goodbye house parties at the  University of Carthage, hello David Servan-Schreiber State. As someone with metastatic disease, I think the hope is that we’ll get time off for good behavior.

A tumor board is the closest thing a cancer patient gets to a trial. A tumor board is like the Justice League of Oncology.  Only instead of Superman, Batman, Wonder Woman, The Flash and The Green Lantern you get a bunch of medical, surgical and radiation oncologists.

It’s a closed meeting–cancer patients generally aren’t invited to provide testimony or point out the accused. (“Ma’am, do you see the cells accused of breaking and entering your lymph system and attacking your vertebral bodies? “Yes, I do. There they are! Right on that slide!”)

Last year my surgeon presented my case to the tumor board. I envisioned Gregory Peck in “To Kill a Mockingbird,” with doctors at tables on either side of a large courtroom, each passionately arguing for some treatment plan.

Suddenly Paul Drake would burst through the courtroom door and hand my surgeon a note. “Ladies and gentlemen, some startling new evidence has just come to light that will prove beyond my case beyond a reasonable doubt,” my surgeon would say, glaring at all present.  “Katherine O’Brien did NOT cause her cancer!”

The defense rests.

Katherine O’Brien is a breast cancer survivor who blogs at ihatebreastcancer.

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  • Fred J. Pane R.Ph., FASHP

    I like the analogy. I have used the Tumor Board as an example of a “Comparative Effectiveness Committee (CEC)” also, because a patients case is reviewed by a group of specialists and the best treatment(s) are determined-radiation, surgery, drugs, or a combination. This isnot standard practice for other diseases. I wish I can also say that every physician runs their patients through tumor boards BEFORE they do surgery. I experienced this with a 37 y.o. cousin and convinced her to go to the hospital I worked at for her breast cancer.