When George arrives with his terrified wife in tow, the fierceness in his eyes above the mask is evident. The stride long and purposeful into the exam room to continue a discussion going on for 15 years. What does the new scan show and now that he is retiring, is there life ahead? George’s lifestyle is good and not impacted by chronic disease. While he is ready to get on with the fun, the scan with some “minor” changes may derail his plans.
Every bit of cancer can never be erased. There are new blood tests that will show infinitesimal amounts of circulating cancer. Does everyone want to know the results? George is on a well tolerated regimen, keeping major explosion of disease at bay, but he is always looking for that truly negative scan. It never happens. We are all weary of finding one more thing. I fear he will want to change to a toxic chemo regimen just because there is a little more “glow” on the pet.
You may say, “Why not, Doc? It’s his to choose”. While this is true, to what gain and adverse effect? When George had chemo last year he thought he was dying. He identified as a patient because his hair fell out. He didn’t want to play golf or be with friends. His immune system suffered and the cancer only minimally decreased. He essentially “lost 6 months” of carefree wellness and honest to goodness life.
No doubt it is much harder for patients to hold on therapy than jump right in. “Fix this thing, Doc”. My philosophy, even as aggressive as our treatments are and effective, is sometimes, especially for a long several- year engagement, to just wait, re scan then move to treat if the disease threatens. Not all cancer in stage four is dire site. Bone and lymph nodes are not as life threatening as lung, liver and brain. And so, my recommendation for George is to enjoy his retirement, the summer, the freedom from this terrible covid year and live. Come back in several months re scan then decide that if stable, continue but if increased, treat.
This is where I encourage you to avoid losing sight of your own goals, dreams and wishes. Oligo-metastatic disease is small sights of treatable metastatic cancers we usually manage over the course of many years. Patients can do well without the insult of continuous chemo. No one should be on therapy from diagnosis until death. Take a breath and make a decision, even for a month to wait it out. This day I wished we had waited to scan George at the end of summer. Knowledge sometimes isn’t power- just voyeurism.
Rest assured that we will not abandon you. Remain on surveillance and choose treatment at the right time, not just because someone scheduled a scan. What a terrible waste of good living. Listen to your own mind, talk with your family and even get another opinion. Always ask your oncologist “What if I do nothing now?”or “What is the plan if I hold off on therapy?” That encourages your doctors to consider an alternative plan of action. A new path may be completely different and even more appropriate for you, your lifestyle and goals. Have faith that you are in control and clever enough to discover the road that is just right for you…right now.