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"I don't want any more chemo!" - (7/28/2020)

By Dr. Ron Gasbarro

Rob was in the pharmacy almost in tears. “Here’s another prescription for my nausea medicine,” he said as he handed the pharmacist the piece of paper. Rob has advanced throat cancer. Although his oncologist said it was curable with a lengthy regimen of chemotherapy and radiation, Rob wants to scrap his treatment. “I didn’t ask for this disease and I didn’t ask for this chemo crap!”“ But you are halfway there,” said the pharmacist. “I don’t know if it is worth it!” Rob cried, “I’m in so much pain!” 

A cancer diagnosis is a life-changing event. While it was once a death sentence, the decades have produced many therapies. Many treatments target the exact site of a tumor, while others are simply more effective at their job. This good news does not mean that these drugs are without side effects. In Rob’s case, he is can barely talk because the radiation has inflamed the area around his vocal cords. He also has enormous difficulty swallowing food, particularly anything that needs chewing. Hence, he is dropping weight, which, in turn, is sapping his overall energy. Rob is working closely with his oncologist, radiologist, and otolaryngologist (ear-nose-throat physician). The nutritionist has asked Rob to consider a feeding tube so that he can ingest enough calories to maintain a healthy weight. This scares him. 

Should all cancer patients continue chemotherapy? Sometimes during the course of treatment, the physician may discuss the wisdom of discontinuing chemo. Drugs may be stopped if they are taking a toll on the patient’s well-being or when the tumor is no longer responsive to treatment. However, this does not mean the patient is going to be discharged without further care. Efforts will be focused on keeping the patient comfortable, infection-free, and out of the hospital as much as possible.    

However, Rob’s cancer is not “terminal.” His physician said (and these are his exact words) the tumor was “very, very, very, very curable.” In Rob’s case, he is relatively young (58) and has lead a productive, healthy, and active life. He was shocked when he got his diagnosis. When his oncologist informed him that his cancer was correctable, he assumed his course of therapy would be a romp in the park. He was not ready for the daily trips to radiation therapy, and the long hours in the chemo chair. The first three weeks were tolerable and he looked forward to his life returning to normal. 

When the radiation therapy removed his ability to speak, he got depressed. His weight dropped because he could not swallow. After 4 weeks, he had enough. Both the pharmacist and his doctor told him that if he does not get rid of the tumor, it would grow and begin to metastasize throughout his body. His condition would worsen and his life span would be greatly abbreviated. He would have to take narcotics to tolerate the extreme pain. His quality of life would go down the drain. Rob took this advice to heart. He had a lot to live for and he did not want to give up because of a few more weeks of discomfort. Rob got his second wind and decided to soldier through the remainder of his therapy.

The pharmacist told Rob that if he needs a hero to follow, then look no farther than Supreme Court Justice Ruth Bader Ginsburg. Justice Ginsburg, at age 87, has begun her fourth round of chemotherapy for recurrence of liver cancer. Does she plan to give up? In a July 2020 statement issued by the Court, Mrs. Ginsburg declared, “I have often said I would remain a member of the Court as long as I can do the job full steam. I remain fully able to do that.” So far, she has. And also so far, Rob has stuck with his treatments. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.  

 


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