Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Patients can live with metastatic cancer

Don S. Dizon, MD
Conditions
May 3, 2018
247 Shares
Share
Tweet
Share

asco-logoMedicine is an honorable profession. We meet people at a vulnerable point in their lives — when it comes to cancer, it is often at their most vulnerable. In oncology, care is typically multidisciplinary, and one of the most important advances in my own professional career has been this team approach. To see a patient with my colleagues from surgery and radiation oncology, and the opportunity for all of us to meet with radiologists and pathologists to fully review and discuss, and then to generate a comprehensive treatment plan has made the care of those newly diagnosed patients less fragmented. I also think it’s more reassuring to those patients, who can rest assured that every member of their treatment team has reached a consensus on how best to approach their particular cancer.

I wish this level of knowledgeable, multidisciplinary cancer care extended beyond the boundaries of oncology, but more often than not, it doesn’t. In fields outside of oncology, I find that the natural history of cancer, and more importantly, the successes we have had (and continue to see) in cancer care are not easily understood. Instead, patients with cancer are treated in ways that still make me cringe — as if every cancer is a death sentence and all patients are terminal, especially if one carries a diagnosis of metastatic disease.

I took care of a woman in her 60s with recurrent ovarian cancer. Her disease had just progressed on a third line of treatment, but she still looked and felt well. We had spoken about alternative treatments, but our conversation was grounded in a reality that this cancer would ultimately be the reason she died. I had talked with her about advance care planning, and she was adamant that she did not want to be resuscitated if she was dying. We filled out the paperwork, and we made her “do not resuscitate” or DNR.

We began fourth-line treatment and unexpectedly (to me) she became severely neutropenic. I discovered this only after I was paged from her local emergency room, alerting me that she had arrived with low blood pressure and a high fever — signs pointing towards sepsis.

“How is she?” I asked.

“Well, her pressure is low, but she is conscious. She’s DNR, so we’ve already called it in: she will go to a medical floor, and we will keep her comfortable.”

I was taken aback by this. “Wait — why aren’t you going to support her? She has an infection, and she’s septic. This has nothing to do with her cancer, and it’s reversible. She should go to the unit.”

This prompted a tense conversation with the attending, but I would not back down. My patient and I had not stopped her cancer treatment, and she had just been telling me how much she was looking forward to the next few months. I had an obligation to advocate for her care — care that I thought was appropriate. However, on the other end of the phone was an attending — a very good emergency medicine attending — who did not know her, did not know her cancer, and did not know what we had discussed. He saw a sick older woman with terminal cancer, now with a potentially life-ending condition. And she was DNR. It felt, to him, the most appropriate and humane action would be to keep her comfortable, and let nature take its course.

Finally, I stopped talking about her cancer and stopped bringing up the reversibility of her condition. “Look, this woman was just golfing the other day. She was babysitting her nieces. She has a good quality of life — in fact, she is enjoying this life, and I think she has a lot more living to do. She wouldn’t want to die on a machine — that she is adamant about — but I don’t think it meant she wouldn’t want to be supported through something reversible where there is a good chance she could return to exactly where she was last week.”

With that, he relented and called the ICU. She ultimately was admitted to the ICU, though I continued to have to advocate for her admission there. Fortunately, it was a short stay, and she recovered to her baseline.

We all come to patients with differing perspectives. Oncology is evolving, and those of us privileged to work in this area have seen incredible advances. But for those not in our field, cancer is still a devastating disease, starting at the point of diagnosis. As oncology professionals, we need to continually recognize this gap in understanding, and we can never stop advocating for the best interests of our patients — and more importantly, their wishes. It requires us to be as honest as we can be with them and take the lead in difficult conversations about prognosis, treatments, risks, and yes, end of life. Even as we initiate palliative care early on, it’s important that we do not accept death from cancer as inevitable, or even as imminent. We need to help our patients protect the good days ahead of them.

Don S. Dizon is an oncologist who blogs at ASCO Connection.  

Image credit: Shutterstock.com

Prev

Why physicians should respect the pain patients report

May 3, 2018 Kevin 4
…
Next

Stranger Things are happening in health care

May 3, 2018 Kevin 3
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Why physicians should respect the pain patients report
Next Post >
Stranger Things are happening in health care

More by Don S. Dizon, MD

  • As an oncologist, this is the hardest role I play

    Don S. Dizon, MD
  • Why physicians should acknowledge the validity of second opinions

    Don S. Dizon, MD
  • A patient who taught an important lesson in doctoring

    Don S. Dizon, MD

Related Posts

  • Cancer patients who want to take unproven supplements

    Marc Braunstein, MD, PhD
  • Obstruction of medical justice: How health care fails patients with cancer

    Miriam A. Knoll, MD
  • As cancer patients wait, states play favorites

    Jaimie Cavanaugh, JD and Daryl James
  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • We must help patients recognize how important their opinions are

    Karen Sepucha, PhD
  • You are abandoning your patients if you are not active on social media

    Pat Rich

More in Conditions

  • Urgent innovation needed to address growing mental health crisis among children and families

    Monika Roots, MD
  • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

    Cheryl Lazarus
  • The unjust reality of racial disparities in pediatric kidney transplants

    Lien Morcate
  • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

    Teresella Gondolo, MD
  • The power of coaching for physicians: transforming thoughts, changing lives

    Kim Downey, PT
  • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

    Althea Halchuck, EJD
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
  • Recent Posts

    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Healing trauma and reconnecting: Unmasking the impact of dissociation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Could Semaglutide Help Curb Addictive Behaviors?
  • 'If the Narcan Isn't Working, Give More' and Other Myths About Naloxone Use
  • CDC: Children's Brain Infections Rose Last Winter, But Remained Rare
  • Inside the Fight Against Burnout Amid the Chaos of War in Ukraine
  • Cardiovascular Risk Models Still Fall Short for Arthritis Patients

Meeting Coverage

  • Cardiovascular Risk Models Still Fall Short for Arthritis Patients
  • De-Escalated Surgery Suffices for Low-Risk Cervical Cancer
  • More Evidence Backs Gout Benefit for Gliflozin Agents
  • Reaction to FDA's Approval of Upadacitinib for Crohn's Disease
  • CDK4/6 Extends Reach Into Early-Stage Breast Cancer
  • Most Popular

  • Past Week

    • Physician entrepreneurs offer hope for burned out doctors

      Cindy Rubin, MD | Physician
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
  • Recent Posts

    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • Healing trauma and reconnecting: Unmasking the impact of dissociation [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the WHO’s pandemic accord is critical for global health care

      Elizabeth Métraux | Policy
    • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

      Robert Pearl, MD | Policy
    • The escalating violence in health care workplaces: a critical problem facing the nation’s health care system

      Harry Severance, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Patients can live with metastatic cancer
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...