Doctor, What Should I Do?
September 27, 2006 – Marc Silver
Web Exclusive: Corporations Unite Against Cancer
September 27, 2006 – Elizabeth Whittington
Web Exclusive: What Parents Can Do
September 27, 2006 – Elizabeth Whittington
Web Exclusive: A Lion in the House
September 27, 2006 – Marc Silver
Multiple Myeloma & Leukemia
September 27, 2006 – Elizabeth Whittington
Coping
September 27, 2006 – Christopher Schultz
Legal Rights as a Survivor
September 27, 2006
Bookshelf
September 27, 2006 – Kathy LaTour
House Call
September 27, 2006 – Aman Buzdar
Mitigating Litigation
September 27, 2006 – Elizabeth Whittington
Cancer with a Known Cause
September 27, 2006 – Elizabeth Whittington
Cure Becomes Less Risky
September 27, 2006 – Alice McCarthy
Classifying & Clarifying MDS
September 27, 2006 – Elizabeth Whittington
When the Choice Is Not Cure
September 27, 2006 – Marc Silver
The Scoring System
September 27, 2006
Do Women Under 50 Need Mammograms?
September 27, 2006 – Beverly A. Caley
Watch It or Treat It?
September 27, 2006 – Beverly A. Caley
Sisterhood
September 27, 2006 – Jo Cavallo
Creating a Dragon Boat Team
September 27, 2006 – Elizabeth Whittington
Arms in Motion
September 27, 2006 – Elizabeth Whittington
Job-Searching Hints for Survivors
September 27, 2006 – Elizabeth Whittington
Working Through Caregiver Grief
September 27, 2006 – Elizabeth Whittington
Fatal Fibers
September 27, 2006 – Katy Human
People & Places
September 27, 2006 – Elizabeth Whittington
Back in Action After DCIS
September 27, 2006 – Nancy Reuben Greenfield
Getting the Care You Deserve
September 27, 2006 – Stacy Beller Stryer
Treatment Boost for MDS
September 27, 2006 – Alice McCarthy
Power to the Patient
September 27, 2006 – Marc Silver
In Situ Breast Cancer: Is It Really Cancer?
September 27, 2006 – Beverly A. Caley
The Shadow Survivors
September 27, 2006 – Jo Cavallo
Taming the Dragon
September 27, 2006 – Elizabeth Whittington
The Choice to Work
September 27, 2006 – Elizabeth Whittington
A Waste of Taste
September 27, 2006 – Elizabeth Whittington
A Cunning Predator
September 27, 2006 – Katy Human
Lessons Learned
September 27, 2006 – Cole A. Giller, MD PhD
Letters from Our Readers
September 27, 2006
A Worry-Free Way to Support Nonprofits?
September 27, 2006 – Emma Johnson
Message from the Editor
September 27, 2006
Doctor, What Should I Do?
September 27, 2006 – Marc Silver
Web Exclusive: Corporations Unite Against Cancer
September 27, 2006 – Elizabeth Whittington
Web Exclusive: What Parents Can Do
September 27, 2006 – Elizabeth Whittington
Web Exclusive: A Lion in the House
September 27, 2006 – Marc Silver
Multiple Myeloma & Leukemia
September 27, 2006 – Elizabeth Whittington
Coping
September 27, 2006 – Christopher Schultz
Legal Rights as a Survivor
September 27, 2006
Bookshelf
September 27, 2006 – Kathy LaTour
House Call
September 27, 2006 – Aman Buzdar
Mitigating Litigation
September 27, 2006 – Elizabeth Whittington
Cancer with a Known Cause
September 27, 2006 – Elizabeth Whittington
Cure Becomes Less Risky
September 27, 2006 – Alice McCarthy
Classifying & Clarifying MDS
September 27, 2006 – Elizabeth Whittington
Currently Viewing
When the Choice Is Not Cure
September 27, 2006 – Marc Silver
Do Women Under 50 Need Mammograms?
September 27, 2006 – Beverly A. Caley
Watch It or Treat It?
September 27, 2006 – Beverly A. Caley
Sisterhood
September 27, 2006 – Jo Cavallo
Creating a Dragon Boat Team
September 27, 2006 – Elizabeth Whittington
Arms in Motion
September 27, 2006 – Elizabeth Whittington
Job-Searching Hints for Survivors
September 27, 2006 – Elizabeth Whittington
Working Through Caregiver Grief
September 27, 2006 – Elizabeth Whittington
Fatal Fibers
September 27, 2006 – Katy Human
People & Places
September 27, 2006 – Elizabeth Whittington
Back in Action After DCIS
September 27, 2006 – Nancy Reuben Greenfield
Getting the Care You Deserve
September 27, 2006 – Stacy Beller Stryer
Treatment Boost for MDS
September 27, 2006 – Alice McCarthy
Power to the Patient
September 27, 2006 – Marc Silver
In Situ Breast Cancer: Is It Really Cancer?
September 27, 2006 – Beverly A. Caley
The Shadow Survivors
September 27, 2006 – Jo Cavallo
Taming the Dragon
September 27, 2006 – Elizabeth Whittington
The Choice to Work
September 27, 2006 – Elizabeth Whittington
A Waste of Taste
September 27, 2006 – Elizabeth Whittington
A Cunning Predator
September 27, 2006 – Katy Human
Lessons Learned
September 27, 2006 – Cole A. Giller, MD PhD
Letters from Our Readers
September 27, 2006
A Worry-Free Way to Support Nonprofits?
September 27, 2006 – Emma Johnson
Message from the Editor
September 27, 2006

When the Choice Is Not Cure

Cancer patients do not always seek a cure if the price could be months of misery from toxic treatment.

BY Marc Silver
PUBLISHED September 27, 2006

Two years ago, my mother-in-law, Jan, went to a doctor complaining of gastric distress and was soon diagnosed with pancreatic cancer. Surgery was not possible because of the tumor’s location. An oncologist proposed chemotherapy to add a few months to her life. “Can you guarantee it?” she asked. He could not. So she passed. She was 84, and otherwise in good health. My wife and I thought she was foolish to turn down a chance to live longer.

But cancer patients do not always seek a cure, or even extra time, if the price could be months of misery from toxic treatment. Patients may not realize they have the right to turn down or halt treatment. Doctors may be comfortable talking about cure but not end-of-life care. Denial can keep both patient and doctor from having an open discussion about what to do when the prognosis is grim.

Some doctors believe in “necessary collusion”—the title of an article in a 2005 issue of Journal of Clinical Oncology. The doctor should not tell the unvarnished truth from the get-go, argues oncologist Paul Helft, MD, the article’s author and faculty member of the Indiana University Center for Bioethics, if it would destroy a patient’s ability to hope. Others disagree: “I believe it is best to be honest,” says Charles Loprinzi, MD. A patient facing dire circumstances will “figure it out eventually.”

Then again, doctors do not always know what will happen. One thing is certain: Patients need to tell their doctors if they want to know the outlook. And doctors need to do a better job preparing patients with advanced disease. Cameron Muir, MD, says a patient with a serious cancer diagnosis should be introduced to the idea of palliative care—managing pain and other problems but not pursuing a cure. “We talk about hope for the best, plan for the worst,” he says. “If you don’t allow people to plan for the worst, they’re more shocked and less prepared” if things don’t go well.

As for my mother-in-law, to the astonishment of her doctors, her symptoms abated after diagnosis. A year went by, and she led her life and enjoyed it immensely. Then she began feeling poorly again. She was hospitalized in June 2005; no treatment could extend her life. “Did I do the right thing by not having chemotherapy?” she asked the doctor assigned to her case. “You had a wonderful year,” he told her. And that was true. In his mind (and in hers) there was no doubt: She made the right decision. 

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