Palliative chemotherapy is largely meant to relieve signs, such as soreness, but it can also prolong life. (posed by a model) Photograph: Alamy
A handful of months in the past, my consultant oncologist sat with me in his area and wrote on the top of a consent kind “Palliative chemotherapy with the intent of relieving signs”. This was my 2nd time facing the chemotherapy wringer for the incurable, unusual sarcoma residing in my abdomen, and a huge decision that I had produced following much deliberation and discussion.
At 31, death was hurtling towards me at an alarming fee, and although the principal determination for both my oncologist and me was to alleviate the pelvic soreness that disturbed my rest every single night, the chemotherapy regimen would also prolong my life.
But what does “palliative” really mean? In the oncology planet, there is a split between curative and palliative treatments. Curative management consists of surgical procedure to reduce out a cancer or radiotherapy to burn cancer cells both are performed with the intent of eradicating the cancer.
I see chemotherapy as sitting on the fence among curative and palliative. For some cancers, this kind of as breast, it is often offered as a treatment method alongside other therapies to improve the chance of cure. For other cancers, like some types of leukaemia, it can certainly be curative in itself. Then there is the palliative technique, where the major intent is to alleviate symptoms this kind of as soreness. However, as chemotherapy effectiveness has sophisticated above the years the lines amongst relieving signs and symptoms and prolonging existence have turn into blurred in the palliative predicament. When it comes to selection producing, this can muddy the waters, as the patient’s primary intent could be existence prolongation or, in some circumstances, misunderstandings and communication failures may lead to a patient believing their treatment is curative.
I first presented with cancer at the age of 29. It came completely out of the blue and at the time my daily life was balancing on a knife edge my kidneys had failed and my entire body was riddled with infection. The cancer had spread to my lymph nodes, liver and bones and had superior at such an alarming rate that the main tumour in my tummy had grown all the way from my pelvis up to my stomach button. Offered the extent of my illness, it was clear that no medical doctor would ever be ready to remedy me. I felt, nevertheless, that I had small decision but to give palliative chemotherapy a likelihood, as the alternative of refusing remedy was going to consequence in a quick demise, which would have been exceptionally difficult for my husband and household.
My original chemotherapy was remarkably successful and gave me virtually two many years of good top quality life. I had been the patient who exceeded everyone’s expectations and lulled these closest to me into a false sense of security. But this efficacy had come at a expense the treatment method was challenging to endure, with intractable vomiting, repeated hospitalisation for infections and numerous blood transfusions. I stopped the initial program earlier than planned due to the fact my good quality of existence was suffering so considerably.
What a lot of individuals never realise is that chemotherapy carries a very actual danger of death and other considerable complications such as heart or kidney failure, not just the effectively-recognised hair loss, vomiting and infertility. Balancing these significant hazards against the prospective benefits which includes daily life prolongation in the last phase of someone’s daily life should be a near extremely hard activity for an oncologist.
Obtaining only just survived my second battering with chemotherapy and even now suffering ongoing consequences, I think the choice to refuse more treatment in potential may be less difficult. However, when a person is offering you far more daily life on a plate it is challenging to refuse. Choosing the far more time alternative does run the risk of ruining the good quality of life throughout any remaining time, and this is an aspect I’ve had a lot of internal battles with.
I firmly believe there does come a point in a circumstance like mine in which death has to be accepted where good quality is pursued over amount in which time at property is valued rather than repeated trips to hospital. I’ve constantly said I would not want to commit my ultimate days lying in a hospital bed hooked up to a drip filled with poison. I hope I will instinctively know when that level is.
How do you know when it is time to refuse treatment for incurable cancer?
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