The Mayor Stops Treatment
Of course I know that Tom Menino is no longer the mayor of Boston, but, for many of us, he remains "The Mayor". The news a few days ago that he had elected to stop treatment (presumably that means chemotherapy), transition to palliative care, and spend more time with his family and friends was shocking although not surprising. From the moment he was diagnosed with cancer of unknown origin that had already spread to his liver, we knew the news could not be good.
Choosing to stop treatment is a very brave and, often, a very wise decision. There comes a time with the toxicity of the treatment is worse than the small chance of a positive benefit. That tipping point is different for everyone, and it can be especially hard to determine if the patient, the family, and the oncologist are on different pages--or at least on different paragraphs. We probably all agree that the patient gets the trump vote, but it can be really tough if beloved family is pushing in a different direction.
Doctors do try to take their clues from their patients and to honestly explain the options with all their pros and cons. Of course doctors are people, too, and everyone has her own views and beliefs that are very real at times like this.
Palliative care is a growing specialty that is different from hospice care; they may go together, but do not always do so. Palliative care means focusing on improving symptoms and comfort and QOL (quality of life); this can happen while active treatment continues. Hospice care means discontinuing active treatment and focusing entirely on QOL issues for both the patient, most important, and the family. I have known people with early cancers who were followed by palliative care because of difficult reactions to treatment and other medical problems. And not everyone who is dying needs the expertise of the palliative care team.
Interestingly, there have recently been a couple of studies that found people who stopped active treatment and transitioned to hospice care lived longer than those who continued with anti-cancer therapies. If you think about it, that makes some sense. People with advanced cancer are dealing with a lot of problems, and chemotherapy may make many of them worse. For example, if your liver is full of cancer, it can't process drugs efficiently, and patients can end up with liver failure if the organ is overwhelmed.
This is an article from Boston.com about the Mayor's decision. We all wish him God Speed
.Why Do Cancer Patients Like Menino Stop Treatment?
When Thomas Menino announced eight months ago he’d been diagnosed with an unknown cancer that doctors said had spread to his liver and lymph nodes, the 71-year-old former mayor of Boston said he was going to fight the disease.
“My attitude really is, we’ll get through it,” Menino told The Boston Globe in March. “We got through the [illnesses in 2012], we’ll get through this. I have great doctors and supportive friends.”
This Thursday, however, Menino announced he was canceling his book tour and stopping his cancer treatment to spend more time with his family and friends. “While I continue to fight this terrible disease, I feel it is time for me to spend more time with my family, grandkids, and friends,” he said in a statement, adding, “I am hopeful and optimistic that one day the talented researchers, doctors and medical professionals in this city will find a cure for this awful disease.”
While many expressed their thoughts and prayers for Menino and his family since the announcement, there was also the uncomfortable sense that this tireless fighter—who hadn’t backed down before, having undergone chemotherapy and surgeries to remove cancerous growths in 2003 and 2012—was giving up too soon.
“He’s doing the opposite of giving up,” said Lachlan Forrow, a general internist and the Director of Ethics and Palliative Care Programs at Beth Israel Deaconess Medical Center. “What he’s doing is saying the treatment is affecting my physical energy and maybe emotional energy more than I’d hoped, and I’m going to fight with all the energy I have for the things most important and the people closest to me.”