Morning Meeting: The Difficult Cancer Questions

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In this morning's meeting, Dr. Sager talks about facing and answering difficult questions.

What does incurable mean?

How long does one have to live?

If you or someone you know if facing cancer, it is important to understand these questions and how to address.


So, over the last 24 hours, I actually got two very interesting emails, or outreaches. One was by text, one was by email, but both sort of in the same line of inquiry, questions, and really talk about something that I think, you know, we talk about a lot internally, but I think all patients would benefit from us hearing.

And they're sort of what I classify as sort of the difficult, difficult questions. This is the hard stuff. The question yesterday morning that I got by text was about a patient who is actually diagnosed with something that was not a true cancer, but that was supposedly incurable and the concern was that does incurable mean without possible treatment, without possible hope and the answer is no and you guys all know this. This is what we do day in and day out.

Helping patients to access treatments that have a good scientific rationale and basis. Even if we don't know yet how well they work, there's a lot of people trying really hard at trying to make these work better than standard and so not that we can necessarily say it's going to be curable. However I think that from my perspective that philosophical construct of curable and incurable is not the best one.

From my perspective the better one is to think about you living with a situation as opposed to dying from a situation. And I think that very much fits with a lot of our patients including our the patient that we began talking about today. Where you know you have a situation which is not necessarily curable, but doesn't mean that demise is... that there's no treatment left. That there's nothing left to do. That there's no hope for continued good quality of life and longevity and to me, those are the two things that we seek for every patient no matter their situation.

When cure can be obtained, we absolutely can go for it and the system is sort of set up to do that with harsh treatments and surgeries and everything else to really try to eradicate the cancer. Because then you know you achieve the goal of not having to face that inevitable outcome.

The fact is a death is inevitable and from my perspective it would be much better for all of those cancer patients who have been labeled as incurable, not to assume or to think that there's no more cancer treatment but instead to understand that there are therapies available. There are things that will give you longevity and good quality of life.

I got an email in the wee hours of the morning asking some of these very difficult questions and again, they're not unique to this patient and that's why I think it's important that every patient understands that they should have these questions and here are the best answers that we can come up with.

So the first question is how long does the patient have to live. And this is a question that I hear from time to time. I think I'll oncologist here this question and it's a question that, you know, as I've been going through my training you know and practice in oncology I've come up with ways of answering that and they're not bad.

You know what I would say to generally help patients to understand is that doctors, everyone, no one in the world can tell them the exact answer to that. So the best we can do is to try to get to like sort of ranges and to me the ranges are: months to years, weeks to months, days to weeks, and for patients who are feeling well and have just been diagnosed with something that may be called incurable but there, but they, have treatment options in front of them and, again, we can find treatment options for patients as long as they want them.

Again, we're in the months to years section. Now, I don't know if it'll be a month or a few months or a year a few years but we have patients with all of those and we have patients who are in the exact same situation who lived for years and have a good quality of life. So, again coming back to the fundamental that we seek to provide longevity and a high quality of life.