I just finished an hour-long telephone discussion with a patient who is overwhelmed by the thought of needing chemotherapy.
She was not expecting the medical oncologist to offer it, and she is not prepared to use "poison" to treat her disease: "It is just not natural, and I do not know how you medical people can stand by and wreck people's bodies." WOW -- it gave me pause!
The conversation was important for many reasons:
- The patient is terrified. She did an Internet search on various sites and became overwhelmed.
- She has a triple negative tumor profile, which is considered more difficult to treat with fewer chemotherapeutic options.
- She read that there are alternative treatments that can cure her cancer so why take the "poison" route? And maybe she will have a recurrence anyway.
- Why aren't there better treatments available? Where's the data that conventional treatments will be successful over what period of time? And that chemotherapy won't instigate another cancer?
I could have spoken to her all day and I don't think I would have the answers she sought. It must be very exasperating to have limited treatment options to choose from that all sound less than desirable.
I really can't speak to the alternative medicine approach as evidence-based treatment regimens are based on FDA-approved protocols and clinical trial information.
A medical literature search didn't turn up much for me to pass on to this patient because she wishes to have statistics that show survival rates of treated vs. non-treated breast cancer patients.
She is having another meeting with the medical oncologist in the coming days. I always remind my patients that the decision is very personal and should be the one that does not keep them up at night --they have the ultimate right to chose what is best for them.
Her conversation made me think about how far we still need to go to find the best therapeutic regimens for triple negative patients and how we can minimize side effects while maximizing efficacy. I am not sure what my patient will eventually decide. My role will be to stand with her, empower her with knowledge on both sides of the debate, and respect the path she chooses.
Has anyone had similar conversations? How did you help resolve the dilemma of treatment vs. no treatment? Are there any websites or support groups designed to fit the needs of breast cancer patients with triple negative tumors?