Cancer doctors don't know when to give up

[Roon]

ATLANTA - Doctors are reporting a disturbing rise in the number of cancer patients getting chemo and other aggressive but futile treatment in the last days of their lives.

Critics of the practice say doctors should be concentrating instead on helping these patients die with dignity and in comfort, perhaps in a hospice.

Nearly 12 percent of cancer patients who died in 1999 received chemotherapy in the last two weeks of life, a large review of Medicare records revealed. That is up from nearly 10 percent in 1993, and the percentage probably is even higher today, researchers said.

http://msnbc.msn.com/id/13105178/

My ex beat hodgkins with chemo. I'd like to think that he would have fought until the very end, on the other hand......

[pooja]

1. give them their pain meds and let them die pecefully

My grandfather was treated up until the end. He succumbed to a heart attack and died. The only good thing anyone had to say was at least he didn't have to suffer in anymore pain.

[adriennui]

38. pain meds? what if they become addicted?

my mother in law was in terrible pain the last days of her...what did they give her? darvocet which was thoroughly ineffective.

[politicat]

61. Who cares? Addiction can be treated later.

If the patient survives, then addiction can be dealt with after the cancer is cured. Putting addiction and cancer in the same sentence is like worrying about dental plaque while having a heart attack.

Besides, for most people in pain, the meds are doing their job and addiction is not possible because the body is using the drug.

[Miss Chybil]

40. Let them decide if they want to fight, or they are ready to go.

It's not yours, or anybody's decision, but the patient's. If they reach a point where they can no longer speak for themselves, then the family must make the decision. Every case is unique. My stepdad beat pancreatic cancer - after a failed Whipple surgery. You never know what can happen.

[ulysses]

54. exactly.

It needs to be the patient's decision. Living wills are good.

[mbperrin]

2. Yes, it's a huge problem, Americans getting too much medical care!

They oughta just die quietly at home taking castor oil..............

WHY is the answer always limiting what regular people get while fat-cat fucks get champagne fountains pissing from David's dick?

Just wonderin'.........

[msanger]

11. The problem is people not having a choice

As I read the report, and from what I see as a Social Worker, the problem may be that doctors define "success" as the patient living as long as possible, while some patients see "sucess" as having a good quality of life.

I don't think the suggestion is that we limit the care given to people, but that rather than doctors deciding what that care should be, the patients and their family decides.

My wife died of cancer in 1992, and we did chemo for the first twelve months after she as diagnosed. It was an experimental treatment, she suffered very bad side effects, but she wanted to try whatever was available. After twelve months we dropped the chemo, and her last 6 months were much more enjoyable for her. Her mom wanted her to try some quack therapy in thelast month of her life, but Anne decided she'd rather have a reasonalby good last month, than a painful two months more.

So I'm all in favor of the patients and their families deciding what the treatment should be, not the doctors and the medical billing companies.

[lindisfarne]

20. A lot of cancer patients choose to keep fighting; they don't want to

let any chance pass them by, just in case. They're willing to trade quality of life for the chance of survival. Often, the physician isn't in agreement but respects the patient's choice. Where do you draw the line? 90% chance? 50% chance? 10% chance? 10% still means 1 in 10 have a chance to live a little longer.

[serryjw]

36. MOST cancer patients are also Medicare

quote........
If you have six months to live, Delray Medical Center is more likely than any other hospital in Palm Beach County and the Treasure Coast to hospitalize you, get you seen by at least 10 different specialists and keep you in intensive care.

snip.....
Fort Pierce's Lawnwood Regional Medical Center & Heart Institute — though less aggressive than Delray — received the region's highest Medicare reimbursement per patient at $19,269, said the report, which analyzed care for chronically ill Medicare patients in their last months of life.

Nationally, overly aggressive treatment of chronically ill elderly patients wastes billions of Medicare dollars without improving the results for the patients, according to the four-year study paid for by the Robert Wood Johnson Foundation.

snip......
"We are wasting a lot of money and we will continue to unless we have an open discussion in this country about end of life," he said
http://www.palmbeachpost.com/news/content/nation/epaper/2006/05/27/m1a_endoflife_0527.html

I lost my 84 year old aunt in the last 10 years. When she was DX she was stage 4 lung cancer. The dr wanted to do chemo which my aunt refused. As this country gets older we will have to come to terms people die. Our obligation is to do a better job of pain management. Spending billions will not save them

[lindisfarne]

44. About this statement: The dr wanted to do chemo which my aunt refused.

Did the doctor suggest chemo as one possible plan of treatment, which your aunt refused? If this is the case, the doctor did exactly what the doctor should do. It is the doctor's responsibility to lay out all the alternatives to the patient, and provide the patient with the relevant information necessary for the patient to decide what course of treatment they want. Only the patient can make this decision (or the legal guardian, if a patient is a minor or mentally incompetent). Once the patient makes a decision based on evaluation of all the factors, the doctor is then obligated to follow the patient's wishes.

In many cases, we don't know all the factors necessary to determine beyond any reasonable doubt which course of action is best; the equation is further complicated by the patient's own feelings regarding level of aggressive treatment and risk they are willing to assume. It very well may be that in another patient with the type of cancer your aunt had, chemo would have been the appropriate course of treatment.

I know that if I were ever diagnosed with breast cancer, I would probably ask for a double mastectomy faster than a person could blink. For many women, this wouldn't be the proper treatment as they would not want to lose their breasts. Even medical protocol generally doesn't call for double mastectomy but my personal identity is completely separate from whether I have breasts and would be perfectly willing to trade them for a much lower chance of a recurrence of breast cancer. Luckily, that form of cancer doesn't run in my family - at least not yet.

[FlaGranny]

51. I lost my mom

at 94. She lived with cancer and took chemotherapy for 10 years - diagnosed at 84. She lived a happy, productive, active 9-1/2 years on chemo. The chemo just stopped working. Sometimes 84 is old and sometimes it is not. If it hadn't been for that cancer, she'd still be alive and kicking and cussing Republicans and voting against them. She would have been 99 now.

[Triana]

29. Thus my contention that Kevorkian is a saint...

....dying with dignity - and dying as a choice instead of running up rediculous bills and suffering longer should be an option to every patient.

Euthanasia is acceptable for our suffering pets. I never understood why it isn't for people.

[lindisfarne]

45. Euthanasia is legal in Oregon. There are legal hoops but it can be

done. All states could enact laws legalizing euthanasia; the US Supreme Court upheld the Oregon law (The US Supreme Court has voted 6-3 to support the Oregon legislation that allows physician-assisted suicide. Euthanasia opponents fear that the door is now open for other states to allow euthanasia and physician assisted suicide. The court ruled that the federal Controlled Substances Act does not allow the U.S. Attorney General to prohibit doctors from prescribing regulated drugs for use in physician-assisted suicide. http://www.euthanasia.com/supremecourt2006.html )

Oregon's law:
Patients must be in final six months of terminal illness
Patients must make two oral requests and one written request to die, each separated by a two-week period
Patients must be mentally competent to make decision
Two doctors must confirm diagnosis
Lethal prescription of drugs prescribed by doctor and administered by patients themselves

[Triana]

60. I hope more states adapt this..

...I think the requirements are a bit much but it's better than in most states. Who decides what the 'final six months' of terminal illness is? The only criteria needs to be if the patient is suffering physically and that no recourse is available to alleviate that suffering. IE: that their quality of life is diminished by the disease to the point that euthanasia is a more acceptable option to the patient than to continue living and this ought to be up to the patient.

Anyway, not to be too picky - kudos to Oregon for a progressive stance on this issue! AND especially for warding off Ashcroft's efforts to override this law. Oregon voters voted on this issue and their vote should stand. The AG should not have the right to override voters' wishes in the state.

[Psephos]

15. This isn't about limiting care to the middle and lower classes

Chemo is literally a poison, and it makes most who take it sicker than they've ever felt. It's no way to leave if you don't have to.

Chemo treatment is also expensive. If it's wasted on people for whom no further treatment will yield benefit, then that money and staff hours are not used for people who could be helped.

There is a finite supply of money and staff available for medical treatment. It's hard to argue with taking a look at whether some of that is wasted, especially when the waste involves increasing the suffering of already-dying people. False hope is even worse than no hope, because it is a lie.

Peace.

[MockSwede]

30. Bingo

50% of healthcare dollars are spent in the last three days of life.....

Hmmm...

Heroics and miracles are honorable and do (very rarely) occur - but as you said, false hope is worse than no hope.

Patients lying to themselves and healthcare providers not owning up to our obligation to help the patient, even if it is to help them face the 'bad news'.

Kevorkian is a saint. Our pets usually get better end-of-life treatment than people. My dog knows I did the best for her, even when it was I who made the 'fatal' decision. No regrets to honor the life well lived, short or long.

[kiahzero]

35. That would seem to be rational to me

Where's that "50% spent in last three days" figure come from, and how was it tallied? If it was simply a matter of dividing total healthcare dollars spent by the amount spent for someone that died three or less days after the money was spent, that would include all the people who suffer from some sort of medical catastrophe and are treated, but ultimately don't recover.

[feduppuke]

3. Isn't that

a very personal decision? My mother accepted a *very* aggressive form of chemo after discovering her pancreatic cancer was inoperable. It allowed her to live for 18 months instead of the 3-6 the doctor predicted.

[Warpy]

4. I've seen a lot of that going on

because cancer docs all seem to consider themselves (male or female) to be the white knignts on the horses, out to obliterate the cancer. In chasing every last cancer cell, they often miss the poor patient in the bed, exhausted, weak, sick, and starving to death.

[lindisfarne]

21. You don't know any oncologists if you believe that. They agonize over

the decisions. Ultimately, the patient makes the decision which are rarely black and white.

[Warpy]

27. Don't tell me what I know, hon

I worked oncology all over Boston.

[lindisfarne]

33. HON??? I'd say your impression of oncologists is unusual then.

The vast majority work with the patients to find out what the patient wants, how aggressive the patient wants to be. If a patient who has a short life expectancy has an event some months down the road (wedding, graduation) they'd really like to make, the oncologists factor that into the treatment plan as well.

In these cases, no one - not the patient or the oncologist - is trying to gain even 5 years (the oncologist is painfully aware that just isn't going to happen). All are well aware that the best that can be accomplished is a slight lengthening of the expected life span. I knew someone who managed to live 14 months when the prognosis was 6 months. She had pancreatic cancer and searched for studies so that, if nothing else, something would be learned from her death. She wanted to have aggressive treatments - even travelling across the country to participate. She wouldn't have had it any other way. Another patient would have chosen to do a simpler approach - and for both patients, both decisions were valid.

Your belief that oncologists are unaware of the patients being weak and dying (while the oncologist chases cancer cells) is unrepresentative of the vast majority of oncologists.

(In case you really are unaware, the use of "hon" as a term for addressing a stranger can be considered insulting. I certainly consider it so.)

[koopie57]

31. You are so right

I work in a pathology lab and it is painful to hear what they go through. The discussions between the pathologists, oncologists and the the doctor doing the procedure itself, it makes me proud to work in this office. It is not unusual for one of our pathologists to call a doctor who ordered a certain test, to call and try to discourage it if it either too expensive can be done with a cheaper test or won't make any difference or is not appropriate. Sometimes the discussion ends with let's get him/her (the patient) home with medications so they can be comfortable and around family.

I know there are some bad doctors, but there are more good ones.

[Beausoir]

69. Nonsense. Can you provide any concrete proof of that?

Or are you just another Dr. hater?

[wordpix]

5. this is difficult. When my father was sick in the ICU, they went way too

far but his (2nd) wife approved every aggressive treatment when he couldn't.

When he could still talk and use his hands, he wanted to sign the papers saying HE would make the choice to die when he said so but his wife kept saying, "Don't listen to him, he doesn't know what he's talking about, he's out of his head." I felt differently, like it was the right thing if he was ready to go. (He looked to me like he was really suffering).

OTOH, what if the aggressive treatment led to his getting better? You never really know how bad someone is. Even when my dad said he was ready to die and wanted to asap, you're thinking, "Maybe he's just out of his head and he can really get better."

Still, I had the feeling he was ready and knew it was time. They kept him alive another week or two and then it was clear he wasn't responding to the treatments, which horribly included a gut operation that I would NEVER have approved.

[wordpix]

6. Forgot to add: moral of the story is you & family members must go over

all scenarios, sign living will and be as specific as you can about possibilities. How bad do you want to get before you want the tubes pulled? YOU need to decide when you're of sound mind, not the doctors.

[CTyankee]

9. I'm just getting info from a lawyer on living wills

My mother had one. I had POA for financial and for medical decisions and I was her guardian. I think it was helpful. I also got her estate, as her only heir, in no time.

Now I'm going to get my own living will. It seems like a good thing, if it doesn't cost too much. We'll see...

[Warpy]

8. Yeah, my pop said he didn't think he was going to make it

but I'm a nurse and I've seen all the horror shows, so I brought the social services folks in and had him tell them exactly what he wanted done and didn't want done. I thought he had good rehab potential, but he said he was tired and didn't want to go to all that bother. He wanted to die, and then he did.

What a lot of folks out there don't understand is that "do not resuscitate" doesn't mean "do not treat." The person will still get appropriate medical care unless s/he specifically starts to refuse things like chemo and invasive procedures. That "DNR" means pain medication will be used much more liberally, though.

When I was going through that house, I found living wills he and my mother had written back in the 50s, before people were really thinking about such things. There was no doubt that I'd followed their wishes.

[LeighAnn]

7. 12 percent doesn't seem that high

It should be up to the patient. Some cancer patients don't want to stop fighting it, and attitude shared by the many who beat cancer after having been told there was no hope.

I wonder what the percentage is of doctors that don't keep up on the latest cancer treatments and don't refer patients to clinical trials. I'll bet it's a lot higher than 12%.

[napi21]

10. I agree with the doctor's report.

I also don't believe this is isolated to cancer patients. Many people want ANY treatment that will prolong life, and I admit, I don't understand why. There is a big diffrence between "life" and "living". If the prognosis of your condition is poor, and treatment (usually very unpleasant) has a 10% chance of prolonging your life, I personally would tell them thanks, but no thanks. Just give me some good pain killers and leave me alone.

I already have the forms completed that include a DNR order.

Unfortunately, I've seen too many people fairly close to me suffer unnecessarily, and then die anyway, when doing nothing would have been much better.

[pooja]

13. personally

If I had cancer and the prognosis wasn't very good, I would choose to live my moments with my family, not puking over a toilet. Also, I would hate to leave a finacial trail a mile long for my family to clean up once I did die.

[lindisfarne]

23. The same concerns should be made regarding very premature babies.

Yet we don't as a society; we spend a fortune keeping alive babies who are severely disabled to the point of almost being vegetables (and whose lifetime care will cost another fortune or two). We try everything out of hope of a miracle. The same is true of the older folks; even with a 10% chance, that means 1 in 10 will live a bit longer. Which might mean you see your child get married, or graduate from college, or you get a little longer with your grandkids. All very important things.

Two months, or 6 months can sometimes mean a lot. Most of these people understand they're not getting 10 years or even 5.

[UncleSepp]

37. As a baby born more than two months premature ...

I'd like to say, sometimes, a mom's got to trust her intuition. This baby wasn't supposed to live at all. Then, wasn't supposed to breathe on its own. Then, wasn't ever supposed to hear or see. Then, might be able to hear and see, but would be so severely retarded it would never be able to function outside of an institution. This baby would like to roll up his master's degree and shove it up a doctor's nose somewhere.

Blah. That probably made no sense. I'm sleep deprived :-P

[Roon]

12. You are all making some great points

I have aids...had it for a long time....I need to update my living will because I am not with my lover anymore.I vote for "do not resuscitate". I shudder at the thought of suffering and not being able to voice my concerns. As long as the pain is managed I think I can go through with this....

[ismnotwasm]

14. Hugs for you

I know it's a long, strange trip.
:hug:

[Roon]

16. Awwww!!

Thanks, Baby....

[wordpix2]

41. hugs from me, too. I am looking into my living will this summer. I'm

healthy but you never know when you'll be in an accident or get some disease. Could happen to anyone, anytime.

[Gman]

17. Had a good friend die a few months ago of colon cancer

there came a point when the doctors said, "that's it. there's nothing more they can do. go home and be comfortable." He died 2 1/2 months later with all the morphine he wanted and needed. He was as comfortable as possible under the circumstances when he died.

[LeighAnn]

53. They told my cousin the same thing, it was a lie

"There are no more treatments available to try" they said before they sent him home to starve to death. Too bad they never checked the NCI database

http://cancernet.nci.nih.gov/cancertopics/pdq

He wanted to fight really bad, too bad his oncologist never recommended him for a clinical trial.

http://www.clinicaltrials.gov/

A lot of oncologists practice the same kind of oncology they were taught 20 years ago, too busy raking in the big bucks to surf the net every once in a while, or read a medical journal. Blessings to the doctors that at least give a person the option of fighting, and let them make their own decisions.

[leftofthedial]

18. they know exactly when to quit

when the insurance runs out and the bank account is empty

[Witchy_Dem]

65. Ding ding ding, we have a weiner

ita

[BurgherHoldtheLies]

19. A longstanding joke in medicine: "Why do they nail coffins shut?"

To keep the oncologists out.

Ya, it's a tasteless (and very old)joke. But this article brings to light what has long been known in the medical community.

[Sadie5]

24. Went through this with my mother

Bone cancer, she was given about six months. She refused all chemo as she has gone through it with Breast Cancer. She could still talk to me about 12 hours before she died so I can't say she was over medicated. The last hours she slept with the help of morphine, and then it was over.

[wordpix2]

42. my sister just refused chemo after taking it a month. They poison you

to kill your cancer cells but the chemo can kill first. It was making her too sick so she just stopped. I don't know what comes next---she has 2 young daughters.

[bemildred]

22. Not giving up pays real well. nt

[leesa]

25. These are bogus statistics. '12% of cancer patients who died in 1999

received chemotherapy in the last two weeks of life'...well, duh! Chemotherapy nadirs occur at about this time and the toxic effects are at their maximum. Also, if the tumor is actively progressing, the last couple weeks can be a real race between treatment effects and tumor effect.

I'm all for backing off on ineffective treatment, but let's give real information here...depends on the disease, it's stage, the patient's life situation (are they young, do they have young children, etc), how much treatment do they want...all sorts of factors play into the decision and most oncologists I know respect a person's desire to let go. Doctors DO want to be able to offer something because they HATE having to say I can't do anything for you, but you may as well blame Big Pharma then for putting so many products on the market.

[Bridget Burke]

34. I agree. We need more information.

The story makes it seem as though "end-stage" patients were being given chemo. Unfortunately, chemo IS toxic. Some patients on the same regimen might have won significant survival.

I note that MD's from major cancer centers were quoted. These are places where it's determined whether each patient should get aggressive treatment, "standard" treatment or palliative care. Might less specialized hospitals be more careless about patient evaluation?

[kestrel91316]

26. Here's a novel concept: ASK THE PATIENT.

It should be totally up to the patient whether or not they have heroic measures to the bitter end and go down fighting, or stop fighting and die with dignity, or some path in between.

NOT the doctor's choice, not the insurance company's, not the state's........THE PATIENT'S choice.

What is so difficult about this concept?

[Vinca]

28. Overtreatment? Something I don't have to worry about.

With no insurance to let me in the door, I'm dead meat anyway. Do you think insurance would be more affordable if unnecessary treatment wasn't given?

[pooja]

32. insurance won't be affordable until Americans

can walk into a dr.s office and get a price quote. until they can price out a hospital, staff, and check the credentials of the practicing staff. when people see that they are being charged 3.00 an aspirin, they'll tell their relatives to go buy the same shit at the store.

[Lars39]

68. That's a RW proposal.

When faced with any kind of serious injury or illness, price-shopping shouldn't even be a consideration.
National health care should be the goal, not the patch-work system that is now in place.

[blogslut]

39. glioblastoma multiforme

Doctors diagnosed my mother with it in 1995. They were so mad when she chose to forgo treatment and die @ home with hospice care.

They claimed they could give her an additional six months. My theory is they wanted to treat her so they could write papers on her. The docs kept going on about how "rare" this cancer was and they always got a little glint in their eyes when they spoke of treatment.

She was already starting to lose her memory and the thought of being poked and shot and cut and bothered until she died, seemed like torture.

She passed away, at home, two months later.

[wordpix2]

43. I would agree with your mother if I were in her shoes. My dad did feel

tortured in the ICU and wanted to let go.

[cyr330]

46. I agree

But I would amend your statement to say that MOST MD's don't know when to give up. I'm a Registered Nurse, and I've seen some outrageous behavior on the part of physicians. I've seen a resident externally pacing (with electricity, of course), a 98-year-old man with dementia who was a "DNR" (do not resucitate). The resident had the nerve to tell me that "DNR" did not mean "do not treat." It appears that he really did miss the bus in medical school. And that's only ONE example.

[lindisfarne]

48. Did you file a complaint about the resident not following the patient's

wishes? If he was breaking the law and what is required under "do not resuscitate" orders, he should have been held accountable. Alternatively, couldn't you have immediately called the attenting physician to make a decision?

[cyr330]

49. I should have done more

His attending backed him up, unbelievably. I was a new graduate at the time and didn't know that I could actually report an MD. In hindsight, I really, really regret it.

[lindisfarne]

50. Well, you tried. And DNR laws might not have been as clear then as

they are now (although depends on the state; in some states the law is still quite vague). WA just passed a law which will allow paramedics to follow DNR instructions; it used to be quite difficult for them to follow DNR instructions because of the red-tape involved with being sure they were valid, etc. But this is just one state out of many.

Some might wonder why a family would call paramedics if a patient is DNR. 1) The family might not be sure what the immediate problem is and 2) the family might want to ensure the patient wasn't in pain, thus getting the patient to the hospital might be the only option.

[lindisfarne]

47. If a drug could extend a cancer patient's life by 3 1/2 months, and

a patient wanted the drug, would people here regard an oncologist who recommended the drug as one possible treatment option as "not knowing when to give up"?

I personally don't find it hard to believe that 12% of cancer patients would want to try every possible treatment, even if it meant chemo in the last few weeks of their life. The gain could be a few months to a year or so of additional life; the cost could be side-effects from chemo and no lengthened life.

It might not be the choice that YOU would make, but each individual patient has the right to make the choice for himself; until the shoes are on your feet, you really don't know what you would choose. The oncologist's job is to lay out the treatment options, the likelihood of their success at lengthening someone's life a bit, as well as their negatives in terms of side-effects, possible shortening of life, etc. Even if the likelihood of lengthening of life by a few months is only 10%, this means that for 1 in 10 patients, their life will be lengthened, perhaps long enough to spend more time with young kids/grandkids, to see someone get married or graduate. Not unimportant factors to consider.

In cases where life expectancy is fairly short, no one, not the patient or the oncologist is expecting to gain an additional 10, or even 5 years. But for some, an additional few months is worth the possible risks. (Some of us are risk takers, where others of us are risk aversive - this shows up in our approach to finances, jobs, recreational activities, and the choices we make when facing a disease such as cancer).

I personally haven't seen any studies suggesting the vast majority of oncologists are forcing treatments on their patients, or misrepresenting the chance of success of a treatment.

(Doctors at the American Society of Clinical Oncology meeting here said Sunday that temsirolimus, an experimental drug from Wyeth, prolonged lives in very sick kidney cancer patients by about three and a half months, a finding that could pave the way for the drug's approval next year. )

[FlaGranny]

52. I agree and ,

personally speaking, I can't fathom myself giving up and refusing chemotherapy until I was in a whole lot of misery.

[CreekDog]

55. There are a thousand things worse

Than us spending a ton of money and effort to prolong life, even when it seems hopeless. I'm actually glad that we are a little bit irrational when it comes to a person's life.

On the list of problems to solve, I consider this one a much lower priority.

After all, we spend much more as a society to determine how to end life with weapons, war and so forth.

[NC_Nurse]

56. You know why there's nails in a coffin?

To keep the oncologists out. ba-dum ching :silly:

Sorry, that's an old joke I heard when working on an oncology ward. Sometimes it's true, sometimes it isn't. Working at a big teaching, research hospital...I saw it happen a lot.

There's a lot of disagreement between docs on how much negative information to share with patients.

Sometimes, we do stupid things in the name of saving a life. The extent of a person's cancer, the aggressiveness of the tumor, the age and relative health of the patient all need to be taken into account. And in the end, it's the PATIENT's wishes that matter and no one else's, IMHO.

[Emillereid]

57. I have personally known about 20 people with cancer -- of that number

5 of them treated their cancers with only alternative/nutritional methods -- they are all still alive and cancer free. Of the 15 others, only one who was treated with chemo is still alive 10 years later -- the others are all dead. There are very few cancers for which chemo is appropriate.

[Bridget Burke]

58. So write up your findings.

Perhaps the New England Journal of Medicine will be interested.

[ulysses]

59. and Audre Lorde died of breast cancer

after having pursued alternative treatments.

There are very few cancers for which chemo is appropriate.

As someone who is alive now because of chemo, I'd be very wary of blanket statements like this. I'd like to see your data.

[davekriss]

62. My Experience

My mother died of lung cancer at 69 just last year.

She was coughing up blood for months, but chose to hide it from everyone. My dad discovered some bloody rags and carted her off to a doctor. Diagnosis: Advanced lung cancer. My mom was too weak from other illnesses for chemo, so they began radiation to try to control the tumors until some strength returned and she could go the chemo route.

The cancer metasticized into her brain and, on my father's birthday, she had a massive siezure. My dad rushed her to the hospital and they hooked her up in the ICU, a half dozen tubes running down her nose and throught and "twilight sedated" so she would not rip them out. There she lay for three weeks, with family by her side (those that could be there). Every couple of hours they'd siphon off a mixture of blood and lung tissue as the cancer was literally liquifying her lungs. They told us she had less than 5% capacity left.

At one point they tried to raise her from the anesthesia and give her radiation (to control the brain tumors), but she refused, so it was back to the ICU.

After the second week, we'd walk into the ICU and I'd see nurses and doctors at the nursing station look at us seriously and just shake their heads. One day a Dr. Kill-daire (I call him that) came in, did some cursory examination of my Mom, then announced she is irrevocably terminal, with near zero lung capacity and a brain full of tumors (I think there were 12 separate tumors). He suggested slowly taking her off the respiratory machine while upping her morphine. He said she'd take one or two breaths, then be dead. Peacefully. But leaving her as she was, with no hope, amounted to cruelty.

My mother, too, always said she never wanted to die hooked up to machines that way, but my father was not ready to make a decision. He kept saying, If there was a God, I'd pray to him just to have one more chance to talk to my wife. Hmmm. I am a Christian (I know that's not too popular around here). I stood in the gap and prayed for him, for what he desired.

After the doctor, they sent around a nursing specialist that helps families with the transition to death. She told us the facts, she'd most likely die after one or two breaths, and she had zero chance of living more than two days. With the tubes, she'd die uncomfortably in a week or two. She says the staff and doctors conferred, and based on their collective judgment they say this with professional certainty. She advised removing her from the tubes and letting her die comfortably off the machines. My father was still not ready to make that decision. But he repeated, if there was a God, he'd pray to Him that he be given one more chance to talk to his wife (of 51 years). Again, I stood in the gap and prayed for him.

I prayed all night, giving it to God, knowing whatever transpired in the room the next day would be His will.

The next day, we walk in, I see the heads shake again out of the corners of my eyes, I hear the hushed conversation. It was clear they thought we needed to let go. Still my father could not make the decision. While standing next to my mother's bed, I saw the thought arrive like a comet landing square on my head and I said boldly, "Take her off the respirator!" With that we agreed. My father was just looking for someone else to take on that responsibility. And I, of course, a prayful Christian, gave that responsibility to the Lord.

Arrangements were made to pull the machines in the evening. We decided to minimize the morphine so her lungs, what was left of them, would have a chance to kick in. And then it started. She came to ... breath one ... breath two ... breath three ... breath four ... she sat up and slowly pulled the feeding tube from her nose (ouch!) ... breath ten ... breath elevyn ... then she talked. To all of us. My father's proxy prayers were answered!

After another week in the ICU they were calling her Carol the Miracle. She was eating, gaining wait, gaining strength. No apparant mental deficiencies (from the seizure). Finally they suggested we move her to Hospice, which we did.

We has Easter Dinner together in her room! She even battled with my father for control of the TV remote (just like days of old!).

(I took several opportunities to minister to her while down there. While in the ICU she accepted Jesus Christ -- OK, you aethists out there, just leave this alone for now.)

I had to go back north to work, so seeing she was growing stronger, and seeing my father (who slept with her in the hospice every night) got his prayer answered, I left them. She continued to grow stronger until Hospice said she's not dying, she should be sent home. So she was -- united with my father and her wonderful puppies. She always said when she dies she wants to die at home, surrounded by those she loves.

Three months later she had another seizure and knocked the temple of her head hard against the corner of a bathroom vanity. She was dead.

I drove down again. The funeral was lovely and we cremated my mother (her wish). She now sits in an urn on my father's bedroom dresser.

When driving north again, late, my daughter asleep and the radio on, I kept hearing a young female voice. It was persistent. I turned off the radio and heard, "David, David, I'm here. I made it, I made it, David, and it's everything you said it would be and more. I'm here David, I made it." It was not audible, but from the internal witness (those of you who know what that is) -- but it just as well could've been audible as it filled the car and my head. The voice, my mom's, was not infirmed, but sounded young and healthy and overflowingly happy. Wishful thinking, you doubters will say; believers understand that this was the Holy Spirit letting me know that my mother is in Heaven with the Lord. All is well with her.

I have almost no grief at the loss of my mother, just joy, and hope I see her again after I pass.

And, as for the cancer doctors, they did the right thing, they tried to end the unproductive, uncomfortable care to let my mother die with dignity. And she died with dignity, just several months after they thought!

Coda: When I said to my father that God answered his prayers, that he returned my mom to him for three months, he said -- "f*ck God, I don't believe that; the doctor's just didn't know what they were talking about!" Ah, prayer life never ends! Now I pray that God sends him a devout Christian old lady to hen-peck him into salvation!!!

And finally, if you're wondering (those of you who have seen other posts from me), I'm an anarcho-syndicalist-neo-Buddhist-charismatic-Christian, not cookie cutter liberal at all. On the spiritual dimension: I have a PhD friend quite knowledgeable about current brain science. He reports that we now know the structure in the brain where experience of the Godhead occurs, and it can be stimulated with electrodes, implying complete determinism and biologic cause of all things of the mind. What my thick-headed PhD friend doesn't get is the mind-event occurs simultaneously with its representation in the brain. Neither lead, both dance together in synchronicity. So much for deterministic materialism.

[hedgehog]

63. Your heading is a literal statement

Given the strides made in cancer care, it makes sense that doctors don't know when to give up. It's the same for many other situations such as dealing with a premature infant. The patient who was doomed ten or five years ago can very well go on to make a full recovery today. It would be wonderful if doctors (and patients) could see into the future so they could know who is going to make it and who is not, but until then they can only make their best guess. For the record, my dad had a massive stroke at about age 50 and my brother's mother-in-law had a very aggressive kidney cancer fifteen years ago. He recovered 100% and she's been cancer free for 12 years. It goes to show that you can't always predict outcomes.

[Megahurtz]

64. Nothing like a little Chemo at the Wrong Time to hurry up the process.....

:sarcasm:

[Spacemom]

66. This is such a difficult decision

My mom struggled with this during the last months of her life. When it became obvious that her care was palliative and not curative, her oncologist always left the decision whether to continue care up to her. She did continue chemo for about 5 months past the time it became obvious she wasn't going to beat the cancer. She asked me what I wanted her to do, and I told her that the only way I could answer that question was selfishly, that I wanted every moment I could have with her, but that ultimately she had to make the decision. She eventually did stop treatment and died about a month later. She died at home with hospice care. It always has to be the patients decision.

[noonwitch]

67. Doctors want to heal people, to a fault sometimes.

I have mixed feelings, like usual. My uncle, at age 48, was diagnosed with meta-sized kidney cancer. This was after a year of complaining to his HMO doctor about back pain, and all his doctor did was give him painkillers. No X-ray, or they would have picked up the cancer earlier.

When they diagnosed him, a 48 year old man with 2 kids, they told him he had six months and didn't offer him any treatment, nor did they offer him a second opinion. They referred him to hospice.

To me, I think these doctors gave up too soon. At least try something before giving up. Even if they gave him another year with his kids, it would have been better than nothing, from his perspective. He didn't want to die, either, despite the pain he had.