Palliative Care

Among my daughter’s many virtues is her alertness to articles that might stimulate a blogpost.  She’s done it yet again with an article in The Washington Post, by Amy Berman, who received a diagnosis two years ago of stage four breast cancer (http://www.washingtonpost.com/national/health-science/terminal-breast-cancer-leads-woman-to-pick-palliative-care-not-aggressive-therapy/2012/04/30/gIQAY6rBsT_story.html).   Her breast cancer, inflammatory breast cancer, is the most deadly kind, with only a 40% five-year survival rate. 

She decided to forego aggressive therapy – intensive chemotherapy, radiation, a mastectomy, and more chemotherapy – which might extend her life for a few months but would, as she knew from her experience as a registered nurse, make her miserable in the process.  “Because my progressing illness is incurable,” she wrote, “I’ve chosen a solely palliative approach, and my oncologist has embraced my choice.  Together the two of us chose a treatment regimen that would slow tumor growth while protecting what was precious to me, my quality of life.  Instead of waging war with a disease that can’t be cured, my doctors and I are focusing on treatment that optimizes how I function and addresses my symptoms,  This treatment will include, when I need it, comfort care for pain symptoms.”

At the beginning of my current treatment, four years after the initial diagnosis of prostate cancer, which had supposedly been cured by radiation and hormone therapy, my new medical oncologist told me that he would begin with hormone therapy and after that treatment failed, as it eventually does, he would proceed to other measures, including chemotherapy.   For the moment, the hormone treatment has slowed the progress of my illness to the extent that I have no symptoms.  I can carry on my normal activities without pain.  As for the next steps after the present regime fails, I don’t know what to ask for.  I don’t know what is more precious to me, a good quality of life or added months of life.  I’ll need to find out how miserable the next set of treatments will make me and how much time they are likely to buy me.   After reading the article my daughter sent me, I know that I must make that decision sooner rather than later.



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