Sara, an 80-year-old, is receiving cancer therapy and she sent email to me. I have decided to tackle a difficult subject. This will be a four-part series.
I’ve been battling breast cancer since 2002. There was 4 years remission when I even had the energy to move and downsize my home and enjoy traveling with a boyfriend. Then in 2008 some annoying pain in my ribs sent me to the doctor. There was no fast diagnosis. My then, primary doctor sat on scans and reports, so I didn’t get much feed back. After almost a year, it was confirmed as metastasized breast cancer in my bones. I was sent to a cancer research facility because the oncologist thought I may have Castleman’s disease, whatever that is. I felt as if I “fell through the cracks”, as far as knowledge and treatment went.
I still see the same oncologist and his treatment consisted of shots: Faslodex and X-geva every week. I did get a second opinion ,six years ago, at the University of Pennsylvania, from an oncologist, a girlfriend had to drag me to. That doctor gathered all my PET scans and reports and agreed with the current treatment. Then this past March ,I was put on full infusion treatment every week. What concerns me now is when do I say enough already. I’m getting past functioning and turn down invites and fun with friends. I asked a nurse practitioner at the oncologist’s when do you know to quit chemo. She said, “You’re the boss, you can always stop treatment.”
That would seem like sky diving to me. Who would let me down easy if don’t go for treatment?
I hear ads for Cancer Centers of America and wonder if that’s the only place to have guidance after going off chemo. Is hospice the next move? I have to ask the oncologist how much I’m on my own other than pain pills from my primary will I be. Hey, we’re talking end of life here. Have you any ideas?
In Cancer Therapy, There is a Time to Treat and a Time to Let Go
There are many cancer patients out there that are in Sara’s shoes. They have started treatment, realizing that the treatment they are receiving will not provide a cure, but may slow the cancer’s progress and prolong their life. As with Sara, the side effects of the chemotherapy are getting too uncomfortable and inconvenient. Her once active social life , is now seeing multiple specialists and the nurses that give her chemotherapy. Many oncologists may be candid about the prognosis, but they are not able to be specific.
As a nurse that has worked in a cancer center, I have found that patients like Sara do not know when to say enough is enough. Many will endure toxic treatments and terrible side effects to possibly extend their life, even if it is a day, a month or longer.
Many deny themselves and their families the comfort care that hospice can provide. It was a real learning experience for me, when, as an RN, I was fired from a cancer center for even mentioning the “h” word to a patient. Yes, and this young woman when on hospice the very next day.
Many cancer centers depend on research money and Big Pharma to support them. So, hospice is not offered and only discussed when the patient and/ or family brings up the subject.
There comes a time, with many patients, that treating the cancer us no longer the right approach and needs to be replaced with preparing for end of life.
In the next article, I will address “making the tough decisions”.