An intriguing idea about cancer as an evolutionary disorder

Why Everyone Seems to Have Cancer

George Johnson, author of a piece in the  NY Times Sunday Review 01/05/14, has an unusual and fascinating take on cancer as an evolutionary adaptive response that gets out of control.  He remarks that as we are exposed to more and more sophisticated medicine we do not succumb as we age as our parents or grandparents did.  He suggests that adaptations in our genes can sometimes result in cancer. Furthermore, he theorizes that everyone will have cancer if they live long enough.

What are the implications for your end of life planning?  If you or a loved one is stricken in advanced years with cancer, how will you decide what you want to do?  if you are younger…middle aged for example, what would you decide?  

There are many different valid responses to this dilemma. Here are two examples:

  1. An 88 year old woman was diagnosed with cancer and elected to go through the surgery, radiation, and chemotherapy. 
  2. A physician diagnosed with terminal cancer at a much younger age decided not to treat the underlying disease and opted instead for comfort care and the best possible quality of life for the time remaining.  

Many of us will have to make choices as to how much we want to fight a potentially fatal disease.  Many things will contribute to our decision including age, financial resources, leaving loved ones, the diagnosis and the prognosis, and the burdens (and side effects) of chemotherapy, radiation, and surgery.

These decisions are well documented in the reality show, “Time of Death” referenced elsewhere in this blog.  Some patients elected extensive treatment and others chose none at all.  Of note was the introduction of Hospice and Palliative medicine in helping many of the subjects of this documentary deal with their illness.

 

 

Robin Young and Ellen Goodman talk about “having the conversation”

Robin Young, host of “Here and Now”, interviews Ellen Goodman about the importance of communication regarding end of life issues.  Go to the “Here and Now” web site to listen to this 7 minute interview.  You will also find a second link to a site Goodman has created that provides suggestions on how to have this important conversation with both your family and your doctor.  The script can be downloaded and printed to help guide you in your planning to have these conversations.

What worries you most about having these conversations?  What would make it easier?  Would  you like a script to follow to talk with your family and your doctor?  You can get them from Goodman’s website.

 

“TIME OF DEATH”… A REALITY SHOW ON SHOW TIME

During the Fall of 2013, a six episode series followed people who were terminally ill to the conclusion of their lives. (Note that there is a new term being used by some in the medical profession:  “advanced illness”).   “Maria”, a 48 year old mother of three children is featured in the first five episodes, documenting her struggle with stage four breast cancer.  The episodes cover the progression of her disease, the impact of her illness on her children, and the family’s concerns about what will happen to them after she dies.  During each episode a second person’s story is told as well.  Each episode has lessons on how end of life is handled by different people with a terminal illness.

I found these stories of brave people and their families to be informative, inspiring and touching.   Many faced the end with courage and grace.

If you have access to “Show Time” you can watch on demand.

Still available in 2017.

Recent events raise important issues for you to consider.

 January 2014

In December 2013  there have been several events which you might want to reflect on in terms of what you would want for yourself.  Once you have become clear, have a conversation with your Medical Proxy and with your loved ones talking about what you would do in these situations.

1.      Nelson Mandela died in early December of 2013.  He was 95 and had been in and out of the hospital with recurring respiratory infections.  In late summer or early fall he was transferred to his home along with substantial equipment to keep him alive but the suggestion was that he would not recover and there was little indication as to whether he was conscious.  (In 2016 Bishop Desmond Tutu has criticized these decisions saying that it deprived Mandela of an opportunity for death with dignity.)

      Would you want to be kept alive in this way?  What do you think the impact on your family psychologically and financially?  Are there religious considerations for you?

2    Ariel Sharon died on the weekend of January 11. 2014.  He had been in a coma for 8 years after suffering a stroke.  The cause of death was organ failure. 

If you were in a coma from a stroke which might result in a long term stay in a hospital or nursing facility, how would you want to be treated?   Would you want to be kept alive or would you stipulate to those who were caring for you to terminate life sustaining care… after how many days, months, or years would you want this to happen?  What would be the impact on your family?  These are tough decisions which you should talk about with your proxy and your family.

3.      You may have read about a 13 year old girl in Oakland, CA who went into the hospital for a routine tonsillectomy and did not survive the operation.  The doctors determined that she was brain dead from measurements showing no electrical activity in her brain. 

Try thinking about this from the perspective of a spouse, yourself, or a  grown adult child or sibling.  What would you do if you were asked to make a decision about removing the ventilator which is keeping her/him alive?  Talk with those you love about your thoughts and possible decisions in this circumstance.

 

 

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