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    Is There a Time to Stop Treatment?

    thinking man

    The American spirit is one that doesn’t like to admit defeat. We like to take that hill, push through the pain, try to succeed just one more time. At least, that’s our national mythology.

    And that’s a good thing, to a point. But when it comes to advanced cancer treatment, maybe our “never say die” national psyche isn’t always best.

    Earlier this month, yet another study showed that most of us don’t start palliative care soon enough. The research, presented at the annual meeting of the American Society of Clinical Oncology, analyzed the medical records of more than 28,000 patients who died between 2007. Their end-of-life care included hospitalizations, invasive procedures and chemotherapy.

    Only one-in-five of these patients received hospice care, that is, care that focused more on quality of life than cure.

    That makes me want to weep. Who wants to spend their last weeks or month puking from chemotherapy, or lying in a hospital bed, or managing recent surgery incisions? I don’t. I bet you don’t. Yet this new study shows that that’s what happens to four out of five of us.

    Look, I get it, when I was first diagnosed, I wanted my docs to do everything. But early stage cancer is different from cancer with lymph node involvement, and that’s different from cancer that’s metastasized to a distant site. People can live with metastases for years, some even survive a decade, or even more.

    But then, there comes a time when the docs have done everything, and still the cancer’s spreading. That’s a time to be brutally honest. If your docs tell you that there’s probably less than six months left, take stock.

    Be honest with yourself. Are your metastases widespread? Are the side effects of treatment making you miserable? Are your docs pushing for experimental treatment? Are they suggesting surgery?

    Obviously, these are medical issues, and I’m not a doctor.

    But if I were in that situation, I would ask a lot of hard questions. What are the odds of this treatment working? What are all the possible side effects? How many people have benefited? How much longer did they live? Weeks? Months?

    I’m moved by this story about a 31-year-old man who died of colon cancer. When his doctor gently told him and his wife that it was time to stop treatment, they actually felt liberated. As his wife said, fighting wasn’t getting them anywhere and “we felt like we were finally allowed to live.”

    If I’ve got only a little while, and I’m well enough, I’m going to go to Paris. I’m going to eat a lot of cream sauces and cheese and drink some good wine. I’m going to have a big party with family and friends. I’m going to the beach. I’m going to sit in my garden and watch the butterflies.

    Live until the last moment. Sometimes, that means stopping treatment.


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