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Saying No to Chemo

Posted 6/1/2016

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  Over the years I have known a few women who refused chemotherapy in favor of complementary/alternative treatments. Of course, I have known many more who did both, but this is another topic. Through the years that I have been at BIDMC, I am sure there have many many more people who said "No thanks" whom I never met. The ones who came to speak with me were people who were at least a bit unsure of their decision and wanted to talk it out and process the choice. I am even more sure that the greatest number of people who spurn what western oncology care can offer never come at all to BIDMC or another place like ours.

  Within the past year or so, I have met two women who consented to surgery for breast cancer, but refused anything beyond that, no radiation and certainly no chemo or hormonal treatment. Looking much further back, I have known three or four women who declined systemic treatment at diagnosis and eventually returned with metastatic disease. At that point, sadly, their cancers were incurable. Might those cancers have recurred even with chemo? Sure, but then again, they might not have.

  As an aside, whenever I talk with someone who is struggling with this or another difficult decision, I suggest that she try to identify the worst possible outcome and then do whatever is necessary to avoid that situation. As a social worker, as opposed to being a doctor or a nurse, this is especially tricky because it flies in the face of one of our central beliefs: to always start where the client is and to support her decision. We are trained to support her decision even if we think (as I do in these moments) that it is wrong and dangerous.

  This is all an introduction to this thoughtful article from Hutch News about people who refuse chemo. Here is the start and then a link:

Alternative reality: Patients who spurn chemo for natural remedies
The breast cancer was curable. The oncologist
suggested chemo, radiation and surgery. The
patient, 28, chose an alternative route – trips to
Mexico for coffee enemas and vitamin infusions.
They didn’t work. About two years after her
diagnosis, the cancer was in her liver and no
longer curable. But it was treatable – with
chemotherapy. This time, the patient agreed.
“For my whole team, that kind of broke our
hearts because she’s young, lovely, beautiful,
and we just thought, oh shoot, now it has
spread and we wish we could have avoided it,”
said Dr. Julie Gralow, that patient’s oncologist
at Seattle Cancer Care Alliance, clinical care
partner for Fred Hutchinson Cancer Research
“But the patients are the ones who, ultimately, have the right to choose – with good education and recommendations from us,” said Gralow, who
monitored the patient’s overall health amid those alternative therapies. She continues treating her.
News of another chemotherapy refusal is reviving focus on alternative cancer therapies – and on what advice doctors should give patients who
spurn the conventional for the natural.


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