Doctor, I don’t want chemotherapy
Dr Sarita Retief explains why chemotherapy is still the best oncology treatment that is available (for now).
When I see a newly diagnosed patient for the first time, I often get these words, “I don’t want chemotherapy” within the first few sentences spoken. As if the patient couldn’t wait to get it off his/her chest.
This is something people talk about casually over a dinner date or at braais. Usually after they have witnessed or heard about somebody dying of cancer; they then declare that they never want to go through such suffering and would never take such treatment to postpone the inevitable.
Then one day your doctor tells you that you have been diagnosed with cancer. You are referred to the oncologist for treatment. Here are the four circumstances when your oncologist would advise chemotherapy:
There are some cancers where only chemotherapy would be able to cure your cancer. This includes cancers like some lymphomas, leukaemia, Hodgkin’s lymphomas and germ-cell tumours.
Without the chemotherapy, unfortunately you will die, and with chemotherapy, you will have a very good chance of cure after four to six months of chemotherapy.
This type of chemotherapy is usually more toxic and difficult to complete. But the outcome is great and therefore it can be argued that the benefits outweigh the side effects.
Adjuvant/neo-adjuvant (preventative) chemotherapy
In this case, the chemotherapy is given because there is a high enough risk that there may be a few microscopic cells that have spread to your blood and that those cells can come back as metastases to your lung, liver or bones later.
Proper dosages of chemotherapy can kill these single or small numbers of cancer cells. The origin of the cancer, the primary cancer, still needs to be treated properly with radiation or surgery.
If we give the chemotherapy before we treat the primary cancer, it is called neo-adjuvant chemotherapy, and if we give it after the primary is removed or radiated, we call it adjuvant chemotherapy.
This type of treatment is also not too easy; your quality of life will be affected for four to six months. But after the chemotherapy, there is a much better chance that the cancer will not return.
This is chemotherapy that is given at very low doses for five to seven weeks, together with radiation. The radiation is the actual curative treatment, and the chemotherapy aids in making the cancer cells more sensitive to the radiation. Because it is a much lower dosage than normal chemotherapy, the side effects are not too much.
Palliative chemotherapy is treatment that is given for a cancer that cannot be cured. The treatment is given for you to have a better quality of life.
Cancer is the reason that you are sick, causing symptoms. If treatment can be given to shrink the cancer, even if it can’t cure it, you will feel better.
The reason why the cancer can’t be cured, is because the cells are just too many. Not all will die and they will eventually build-up resistance. This means that you may have treatments for a few months, followed by periods without treatment. If the cancer becomes problematic again, you start a session of chemotherapy again.
So, after you have seen the oncologist for the first time, you will go through a process called staging to determine how advanced the cancer is. When all the facts are on the table, you will know if and why chemotherapy is advised.
- If it’s given to cure your cancer, please do it.
- It remains your choice, if it’s given as prevention. It’s like an insurance policy; it will keep you more secure, but at a cost. Make peace with your decision. If you decide to take it, don’t feel like a victim. Feel empowered that you are doing it for a better future. If you decide not to take it, make sure that you are not anxious about your decision afterwards. Your oncologist will give you good advice for your specific situation.
- If it’s given to enhance the effect of radiation, it makes logical sense to do it.
- It is all up to you, if it’s given as palliation. Discuss with your oncologist. It all depends on how sick you are and how sensitive the type of cancer is for treatment. You have the luxury of deciding if you want it, and even when you want it. The golden rule is that the treatment must be working and that your quality of life must be better. Before every treatment, the decision must be made on the basis of whether you achieve these two goals. If not, stop the treatment. Try another one. Chemotherapy usually can be stopped, though this does not mean that all treatment is stopped. You will still get other supportive treatments. The biggest mistake that can be made, is if chemotherapy is just given as a show of doing something.
Why do people decline chemotherapy?
After being informed about the benefits of chemotherapy, I find that there are still two reasons why patients would decline it.
- They believe that they will be cured by something else. This can be by faith or by an alternative treatment. Patient choice is a right and needs to be respected. But please monitor the cancer’s response, with follow-up consultation after one to three months, and repeat all the tests. If your approach is not effective, it’s time to change your treatment. Hopefully to what your oncologist advised.
- They believe that they will not be cured, and would rather die peacefully without interference. Doctors’ thinking is that if you break your leg, it is fixed with surgery, and it doesn’t grow on without interference. This is done because doctors can relief suffering. That is the same reason why we treat cancer more actively. Numerous studies have shown that doing nothing causes much more suffering.
So, the whole issue of having chemotherapy or not, is more complicated than a mere “No, thank you.” Usually people that are terminally ill with cancer are so sick, not because of chemotherapy, but because chemotherapy is not effective any more. In the right place, at the right time, it is still the best treatment that we have available (for now).
MEET THE EXPERT – Dr Sarita Retief
Dr Sarita Retief is currently working as a clinical and radiation oncologist at Nelspruit Mediclinic in the private sector. She completed pre- and post-graduate studies at the University of the Free State.
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