Desperate, But Not Serious

Diseases desperate grown
By desperate appliance are relieved,
Or not at all.

-Hamlet, Act IV, scene iii

Desperation, one of the fiercest of emotions associated with life-threatening illness, sometimes ignites inside of patients and sometimes just slowly kindles to flame. No matter with what speed it travels its ultimate goal is to scorch the hope we need to persevere when faced with a disease such as cancer.

As a health care provider (formerly known as "physician") one of my duties is to try and douse anguish before it holds "illimitable dominion over all," as Poe would say. This of course is just one task in my mission to "provide" what the panjandrums call "health care," along with whipping out the script pad and maybe even barking out a "get-in-there-and-fight-fight-fight" pep talk. There's nothing wrong with getting everyone to focus on creating an atmosphere of hope, or at least cautious optimism, but do such maneuvers help relieve desperation? Based on my experience I would say yes, but...

Yes, but what patients really want is to be rid of their cancer.

Now we're talking about a real job - finding and then safely delivering the best treatment to kill cancer cells. When such treatments work not only do patients feel better physically but desperation's hold on the psyche almost always is loosened.

Sounds like a happy ending - so what's the issue here?

No problems at all, except for one thing - sometimes the oncologist becomes desperate.

Like a pilot who suddenly stares at his instrument panel with total bewilderment, every now and I find myself sitting wide-eyed at my desk asking "What do I do now?" The last time this happened was only yesterday, when I had to come up with a new chemotherapy regimen to help a patient with gastric cancer whose new symptoms of pain and nausea rudely announced the end of remission.

As we all know, desperation can lead one to make hasty decisions which may turn out to be acts of brilliance or exercises in futility (or even fatuity, God forbid). One would think that a frantic oncologist does not exactly portend jubilation, but in my case it would have been appropriate to consider my anxiety as an auspicious sign. Had I lost my mind?

Of course not - I was concerned not because I couldn't find a chemotherapy regimen to help my patient, but because there are so many effective regimens for the treatment of gastric cancer available I couldn't decide which one to use.

Now that's the kind of panic I can deal with. Hopefully our friends wandering through the Land of Oz, also known as Congress, will allow Big Pharma to continue to develop and market new, more effective cancer treatments - before the situation becomes desperate.

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After my unceremonious exit (crash and burn style)from a relatively standard chemotherapy regimen, the thought of further treatment, if ever required, left me a little apprehensive.

Your post was comforting in its optimism of the many new and effective regimens available.

It is good to know that one can be "cautiously optimistic" with regard to existing and, hopefully, future treatments.

A nice "feel good" post.

It's a nice problem, to have so many possible treatments. Of course, for too many cancers, such as kidney cancer and pancreatic cancer, there are far too few.

And even when there are many treatments, all we really need is one cure.

We are waiting, and waiting, and waiting...

"I was concerned not because I couldn't find a chemotherapy regimen to help my patient, but because there are so many effective regimens for the treatment of gastric cancer available I couldn't decide which one to use."

Dr. Hildreth, why don't you use CSRAs for your patients? The assays go by many names, sometimes chemosensitivity tests, and I'm talking specifically about assays using cell death (and not proliferation) as the end point. The common response is that testing individual tumors in the lab does not predict how the cells in the body would react, and that is not so. If the mouse were such a good cancer model, we wouldn't be talking about the lost war on cancer. It's a topic too complex to entertain here and I'm not an oncologist but I will say the technology has gotten only two thorough and fair hearings. The last one lasted six months of 2006 and when it was finished, the northern California medicare carrier decided to pay for the assays for CLL, all solid tumors, and others on a case-by-case basis. I'm sure you know insurers don't like to part with their money. So for what it's worth -- and it could be worth so much to your patients AND you sound like a fair-minded guy -- you should look into it, and look past the self-serving ASCO opinion that would prefer to restrict this very worthy technology to clinical trial settings.

By Marnie S. (not verified) on 02 Oct 2007 #permalink