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"But Doctor, What Have I Got to Lose. . . ?"

Gregory P. Kalemkerian

University of Michigan, Ann Arbor, MI

To the Editor: Several years ago, my father underwent treatment for metastatic colon cancer. After a very good response to initial treatment, the disease progressed and his performance status and liver function began to decline. During a visit home, I accompanied him to see his oncologist, an experienced private practitioner in New Jersey, who broke the news of the progression. When my father asked about further therapy, specifically the possibility of treatment with irinotecan, which had just been approved for second-line use, his oncologist explained the potential risks and benefits of treatment, and his belief that the risks of further therapy outweighed the benefits. Then he said to my father, "Pete, I don’t think there is anything I can do to prolong your life, but I know there are things that I could do that could shorten it." My father understood him clearly.

As an oncologist, I also understood all too well the point that my father’s oncologist was trying to make, and I have paraphrased his words many times to clarify the concept of risks versus benefits for my own patients. My academic practice consists primarily of patients with lung cancer, so much of my clinic time is spent having conversations such as that presented in the excellent essay by Harnett and Moynihan.¹ Dealing with the disappointment, and at time anger, engendered in patients and their families by conversations about the limited benefits and substantial risks of further active anticancer therapy is the most trying aspect of my professional life. These feelings are probably amplified by the academic setting, in which we are always supposed to have some promising new treatment that will provide further hope. Although I strongly disagree with the all too common practice of continuing toxic treatment with little or no chance for benefit, I understand why many of our patients and colleagues favor this approach. In recent years, the excessive optimism projected by the oncology establishment and mass media about the myriad breakthroughs in cancer treatment that are just around the corner has made it even more difficult for patients to focus on the quality of their lives, rather than the search for the miracle drug that will cure their terminal illness. We have clearly made great strides in our fight against cancer, but in honest discussions with our patients, the future promise of safer, more effective treatments for the most common cancers needs to be tempered by the grim reality of the present. I applaud Harnett and Moynihan for bringing this important issue to the forefront and for offering insightful advice on how to improve communication on this topic with our patients.

	NOTES

 
Originally published in Journal of Clinical Oncology, Vol 19, No 18 (September 15), 2001: p 3904.

	REFERENCE

TOP REFERENCE

 
1. Harnett PR, Moynihan TJ: "But doctor, what have I got to lose. . . ?" J Clin Oncol 19:3294–3296, 2001[Free Full Text]

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• "But Doctor, What Have I Got to Lose. . . ?"
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This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kalemkerian, G. P. Search for Related Content PubMed PubMed Citation Articles by Kalemkerian, G. P. Related Articles Related Article Social Bookmarking                            What's this?