Ineffective and uncontrolled

Issue: BCMJ, vol. 56, No. 8, October 2014, Page 377 Editorials

"And what do you do?"

I dread being asked this question because my answer is often followed by the enquirer listing all of his or her recent symptoms in painstaking detail. However, because my mother taught me not to lie, I told the middle-aged woman sitting beside me on the airplane that I was a family doctor. This led her to share the story of her husband's heartbreaking struggle with cancer, to which he eventually succumbed. After surgery, radiation, and evermore toxic rounds of chemotherapy, he was told that he had a few months to live. The woman went on to explain how they had seen a number of alternative health practioners who gave them hope when all was lost and offered further treatment. Sadly, he lived the expected few more months despite shelling out thousands of dollars for these treatments. 

I can understand patients and their families looking for alternatives when they are told nothing else can be done to prevent them or their loved one from dying. They grasp onto whatever therapeutic hope they have left--rationalizing that the cost is small when human life is part of the equation. I'm sure many of you have patients who have gone to clinics in the US or Mexico, where they claim to be able to help terminally ill cancer patients. However, this woman's husband was treated in my community with vitamin infusions, herbs, hyperthermia, and more.

I am sure many alternative practitioners believe in their treatments, but the fact is that they are profiting from terminally ill patients. I realize that oncologists and others also make a living taking care of cancer patients, but they adhere to evidence-based medicine and drug trials. It breaks my heart to watch families invest their savings in treatments that have little evidence to support their use.

It is a difficult conversation to have with dying patients and their families--advising them to discontinue these therapies--particularly when the alternative practitioner is advocating the opposite. I find it frustrating that there doesn't appear to be any control over these groups, and it makes me angry that I am powerless to stop it. If I were offering a for-profit treatment for terminal cancer without evidence of efficacy, I would be brought before the College in no time. These patients and families are already going through so much; they shouldn't have to sift through this quagmire of unproven cancer treatments in addition.

By questioning the benefits and appropriateness of these treatments I am often accused of mudslinging, turf protecting, or worse. Surely, there must be some course of action for us to take. I am sure it's a horrible thing to be told that you have run out of life-prolonging treatments. However, I think it would be better to focus energy on spending time with family and friends than delaying this process by getting involved in costly, ineffective therapies. I will continue to try to shield my dying patients from this practice, but I often feel powerless to stop it.

David R. Richardson, MD. Ineffective and uncontrolled. BCMJ, Vol. 56, No. 8, October, 2014, Page(s) 377 - Editorials.

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