A nurse with fatal breast cancer opts for care oriented to quality of life rather than quantity of life.

This article in the Washington Post  in September 2015 articulates a clearly chosen path for a breast cancer patient to seek comfort care through a palliative approach rather than aggressive care which was discerned to not bring much relief, extend her life, or offer a good quality of life. The patient, Amy Berman, is a nurse with a clear eyed perspective on her cancer enabling her to choose quality of life over quantity of life. To date, she has had five reasonably good years without the debilitating effects of chemotherapy.

Note that the treatments she received to shrink tumors on her ribs involved radiation, not to kill the tumor, but to reduce it and thereby provide her with greater comfort with less pain. Palliative medicine can sometimes be aggressive in the service of creating a better quality of life. Surgery is another option, although it has not been part of Amy’s treatment.

What is unfortunate is that unlike Amy, many patients are neither medically trained nor sufficiently experienced to see that there are options other than aggressive care. “Curative” (aggressive treatment approaches) treatment is often selected because of a diagnosis that naturally creates anxiety about mortality. Added to this is our faith and hope that technology and medications can solve our problems.

Further pressure comes in the form of advertisements from hospitals and treatment centers. There is increased advertising offering solutions to the dilemma of how to respond to a diagnosis of cancer, heart disease, etc.  Some imply that you should seek out “this” or “that” treatment because “you owe it to your loved ones…” that can be seen by some as a thinly veiled guilt trip.  Given that some new treatments are showing great promise, the challenge is to sort out what is realistic from what is appealing because it eases our anxiety.

At the very least, the medical establishment needs to make these options clear to patients. It requires that doctors talk honestly with you about the treatments, probability of success, and cost in terms of side effects. Doctors vary in their ability/willingness to engage in this conversation with their patients and their families. An “optimism bias” lurks here that naturally causes humans  to embrace the positive solution that they most want.  Combine this with doctors wanting to give you hopeful news and there is a potent force to ignore the down sides of aggressive treatment.  Do you think that your doctors are capable of talking honestly about your mortality?

You might want to consider reflecting on what you would want if you were diagnosed with a fatal cancer and what choices you would make if you had a 5% chance of recovery or a 50% chance of recovery.  It’s hypothetical, of course, but by sharing your thinking you can inform those you care about as to your initial thinking.

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