When the Diagnosis is “Incurable” Cancer
Dr. Richard Frank—
The following article by Dr. Richard Frank originally appeared on Bottom Line/Health.
Receiving a diagnosis of cancer is always frightening, but it can be devastating if you’re told that the condition is "incurable."
For all cancers combined, about two-thirds of patients will be cured (have no evidence of disease five years after being diagnosed). However, many people are diagnosed when a cancer is at an advanced stage, when it has spread (metastasized) beyond its original site to other areas of the body. At that point, a patient typically will be told that the cancer is "stage four" — and not curable.
Latest development: Thanks to the ongoing development of sophisticated new treatments, many cancers that are labeled as incurable can now at least be controlled for several years as chronic conditions.
Treating Incurable Cancer
When diagnosed with an incurable cancer, a patient should ask his/her oncologist to clearly explain the cancer type… the extent of its spread in the body… the average prognosis (assessment of the future course of the disease)… as well as treatment options — both "standard" therapies that are widely available and "experimental" ones that are being tested in clinical trials. It’s also a good idea to obtain a second opinion from another oncologist, especially if the center where the patient will receive care does not offer clinical trials.
One man’s story: I once treated an active 60-year-old man diagnosed with gallbladder cancer that had spread to his liver. His surgeon had told him that the tumors in his liver could not be removed and that he had six months to live. Undaunted, the patient began chemotherapy and his cancer responded well. He continues to receive periodic chemotherapy treatments and now is a still-active 65-year-old.
Many individuals are living with "incurable" cancer — often significantly better and longer than they ever expected. Although advanced cancers still claim the lives of patients, a variety of new therapies now offer real hope for many.
Example: A woman with metastatic breast cancer may receive one of seven hormone-blocking drugs that can be used to fight the spread of the disease. When one stops working, another can be tried. At the same time, she has more than 10 chemotherapy drugs that can be used singly or in combination.
We also have smarter ways of administering cancer treatments that are more effective and less toxic, including using smaller doses of chemotherapy but at more frequent intervals. This approach is less harmful to noncancerous tissues (so that the nausea and weakness caused by chemotherapy is generally much milder than it otherwise would be) but equally effective against the cancer itself.
In addition, "targeted" therapies have been developed that block specific pathways of cancer growth. These therapies, which may be given alone or in combination with chemotherapy, often have fewer side effects than chemotherapy.
Examples: Rituximab (Rituxan) for the treatment of lymphoma… trastuzumab (Herceptin) for breast cancer… erlotinib (Tarceva) for lung cancer… and sunitinib (Sutent) and sorafenib (Nexavar) for kidney cancer. How to get the best possible results in cancer treatment…
- Remember that every cancer is unique. Two people diagnosed with exactly the same cancer will almost certainly experience their disease differently. Their cancers will grow at different rates and respond differently to various treatments.
In formulating a patient’s plan, an oncologist will consider a number of factors, including the aggressiveness of the cancer… the health and age of the patient… the side effects associated with a specific treatment… the availability of clinical trials… and the patient’s wishes.
My advice: Understand that the treatment of an incurable cancer often continues for the life of the patient (with occasional breaks), so there’s no way your doctor can predict at the onset of your disease which sequence of cancer treatments will work best. For each patient, the treatment strategy often is a "work in progress."
- Make sure you have a good rapport with your oncologist. Patients with incurable cancers see their oncologists often, and open communication is critical to successfully managing their cancers.
An oncologist should be empathetic, sincere and caring — and should take time to answer any questions the patient has. Oncologists also should provide a sense of hope — not false hope, but a realistic appreciation that people with chronic cancer are living longer than ever before and often much longer than predicted in the initial prognosis.
My advice: Be honest and direct with your oncologist about how you are coping with cancer and its treatment. This will help ensure that you receive the support you need — and the treatments that are best for you. If you don’t communicate openly, there’s no way your doctor can know your state of mind or how cancer-fighting medicines are affecting your body.
- Focus on quality of life. When a person is living with a cancer that can be controlled but not cured, the ongoing treatments must be compatible with a reasonably good quality of life. The practice of using smaller doses of chemotherapy more frequently (often weekly) rather than larger doses every few weeks may not only reduce side effects, but also help maintain a patient’s sense of well-being. Some patients can carry out all of their regular activities, while others will need to rest more and cut back on some responsibilities.
If it becomes apparent at some point that a cancer’s growth cannot be controlled and that treatment is doing more harm than good, the patient may want to enroll in a hospice program, which focuses on comfort, control of pain and coming to terms with the end of life.
My advice: Find a treatment location that is near your work or home. Also, don’t hesitate to get psychological support for yourself and your family. Free counseling services are available at most treatment centers and through organizations such as CancerCare (800-813-4673, www.cancercare.org).
Also helpful: Focus on yourself. Rest when you need to rest. When your energy is high, do the things that you want to do. Celebrate good results… laugh as often as possible. Surround yourself with friends and loved ones and tell them how they can help you — by assisting with household chores, for example.
Richard C. Frank, M.D., is director of cancer research at the Whittingham Cancer Center of Norwalk Hospital, medical director of Mid-Fairfield Hospice, and Clinical Assistant Attending at Weill Cornell Medical College. He has been appointed cancer expert for WebMD and was named a “Top Doc” in the New York Metro area by Castle and Connelly.