Cancer: Aggressive Treatment or None at All?
Over the past few years, I’ve witnessed the growth of a company that I’m infinitely proud to be associated with. I serve as the Medical and Policies Director of Gilbert Guide and have worked with my children, Jill and Jason Gilbert, to start this company and fill a need in the long-term care market that has, until now, been egregiously ignored. There is a dire need on the part of families for quality information on quality care. I have witnessed this need firsthand in my own practice. Let me tell you about my background and the field in which I work: oncology.
I am a radiation oncologist and have practiced medicine at the university level as well as in community cancer centers and private practice arenas. I have authored over 40 papers on oncology and edited or co-edited 13 textbooks in the oncology literature. I am presently the Medical Director for the Ben Schaffer Cancer Institute of Lodi, and physician of the year for the Oncure Medical Corporation.
My biases for formulating treatment plans for patients are based on what is now called evidence-based medicine (EBM). This philosophy of medicine is based on certain guidelines. For example, is there scientific evidence of benefit to the patient that outweighs the complications of a particular treatment program? Will patients experience a prolonged quality or quantity of life and/or improvement in the quality of the remainder of their lives? This evidence, for most of the common situations in oncology, has been quantified into a ranking system, which is based on the strength of the scientific evidence found in either key articles in medical literature, and/or published studies.
The National Comprehensive Cancer Network (NCCN) summarizes much of this data on their Web site. NCCN is a consortium of major cancer centers—some of the most prestigious in the nation. NCCN receives minimal support from the treatment industry and thus remains as unbiased as possible. In future blog articles, I will frequently refer to the proposed alternatives listed by NCCN and state what their level of evidence might be.
There are many instances in the complex world of oncology where the problem the doctor faces is not effectively or easily addressed by NCCN. This may be due in part to a patient’s unique circumstances (e.g., regarding finances, insurance coverage, living arrangements, family wishes, etc.), or the perceived ability of the patient to tolerate the proposed treatment.
In addition, it must be emphasized that oncology is as much an art as a science, and frequently the exceptions to the rule dominate our experience. Therefore, we are going to deviate, at times, from a clear prescription for any particular situation. But we always have the guidelines to fall back on as a safety net—even though the patient may not be offered the treatment due to multiple outside forces.
Quality of life is paramount in patients who cannot be cured of their cancer. Since each patient’s philosophy is different (in reaction to discovering that their cancer is incurable), we may discuss not pursuing active anti-cancer treatment or may discuss pursuing aggressive treatment. Some patients prefer to accept a treatment that has a low chance of benefiting them, but is still the best we have to offer. Others may feel that the benefit proposed is not worth the potential complications.
Finally, we emphasize relief of symptoms and prevention of complications of the cancer to the degree that we can. This may mean the use of symptom-only treatment via hospice or palliative care. Alternatively, we may employ active and locally aggressive anti-cancer therapies in tandem or separately.
Our center uses many alternative and complementary treatments to help patients through their course of either curative or palliative treatment. Harnessing the mind, the body and the spirit are real benefits. Such disciplines as Eastern medicine (acupuncture and herbal remedies), integrative imagery, yoga, tai chi, massage, psychology, physical medicine and homeopathy may be of benefit. This will be addressed on the Gilbert Guide Blog as well. There are a few excellent sources of information in this area. I have asked the members of my consortium, the Lodi Wellness Center, to keep us informed about Eastern medicine, senior pharmacology and nutrition. Please check back as these expert blog corners will be launching soon. I look forward to penning regular articles for the blog and welcome your comments.
Harvey Gilbert, MD