When discussing cancer treatment, the approach matters

Dr. Peterson, the radiation oncologist, gets right to the point.

“The medical center’s tumor board has concluded that your cancer is inoperable, incurable and untreatable,” he says flatly. “Any chemotherapy or radiation treatments would be palliative in nature.”

He begins explaining the reasons behind the board’s verdict, but everything he’s saying washes out. My mind stopped working as soon as I heard the words “incurable” and “palliative.” I am sliding into shock.

Dr. Peterson pauses.

“I thought you knew this,” he says hesitantly.

“Well, two weeks ago, I got a much better prognosis from Dr. Lowe, who’s a cancer surgeon,” I say. “He and I discussed my having surgery.”

Clearly unsure of what to say, Dr. Peterson quickly returns to the board’s findings, but I interrupt him.

“What would happen if I choose to decline treatment?”

“There’s no reason to be afraid of chemotherapy and radiation,” he begins.

“I’m not afraid,” I interrupt. “My main interest is quality of life, not longevity –”

“If you do nothing, you’ll be dying, and there will be no quality of life,” he cuts in quickly. “The sooner we begin chemo and radiation, the better off you’ll be.”

We continue to talk past each other, and the conversation deteriorates until we reach a dead end.

“I’m sorry,” he says finally. “I’m pretty young” — he looks to be in his thirties –” and I don’t have that much experience in dealing with messy situations like this.” His voice and face betray his discomfort.

He takes me across the hall to meet with Dr. Richards, the medical oncologist who will be coordinating my care.

On Dr. Richards’ desk, I see a treatment consent form already filled out and awaiting my signature.

Without any civilities or inquiries into who I might be, how what’s happening to me is affecting me emotionally or how my values and preferences might influence my decisions, Dr. Richards unleashes a torrent of numbers about my particular kind of cancer — its prevalence (rare), nature (unusual) and existing research (there’s little in the literature). The data, expressed in a language I cannot yet understand, further numbs my brain.

Finally, he comes to the point: He plans to subject me to the most aggressive and brutal course of chemotherapy possible.

“There are possible side effects,” he cautions, “but they’re worth it because I’m going for the cure.”

“But the tumor board says that the cancer is incurable,” I say.

“Well, it’s true … a cure would be nothing short of a miracle,” he admits, his tone businesslike. Without missing a beat, he continues: “I’ll be using three chemotherapeutic agents, and the regimen will run for two months; you’ll have a mix of visits to the infusion center and use of a home infusion pump. That should shrink the tumor and buy you some time –”

For the second time in one day, I interrupt a doctor.

“My overriding concern is quality of life rather than longevity,” I say.

He regards me impassively. I can tell that he is losing interest.

“What would happen if I do nothing?” I ask.

He recommends exploring hospice care.

“Would chemo enhance the effectiveness of the treatments the radiation oncologist is proposing?” I ask.

“Yes,” he answers, but reminds me that the radiation oncologist, like himself, is recommending the most aggressive treatment in hopes of a miracle.

“Then a less brutal regimen would be to go to Lourdes,” I say facetiously.

To my astonishment, he nods. “A trip to Lourdes would be a better use of your money.”

He looks at his watch. “We can’t spend all day on this,” he announces impatiently.

In silence, he prints out a brief summary of the chemotherapy options.

“Look it over and call me when you’ve decided on one,” he says.

He stands. The meeting is over.

Disoriented, confused and enmeshed in a web of disbelief, I leave. Only later, when anger begins to temper the shock, do all the things I could and should have said come to me. I write them down but put the list aside until I can find another oncology team at a different center.

After some searching, I select a new team. And, in truth, I eventually go with the chemo and radiation regimen recommended by Drs. Peterson and Richards. But the new team helps to make the decision an entirely different experience for me.

From the first visit on, they listen closely and respond to my concerns and fears. They solicit my feedback on their recommendations and spend time explaining my options. They too talk about numbers and data and algorithms, but they also listen to my story, and I can tell by their questions and comments that they value what I’m saying.

I know that they are highly competent medical professionals. But the way in which they relate to me — as one human being to another — convinces me that they also understand the personal side of medicine, and that they will bring to my care not only the aim of curing but also the art of healing.

The trip to Lourdes can wait.

Michael Carbine is a retired health care business writer. This article was originally published in Pulse — voices from the heart of medicine, and is reprinted with permission.

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