First question: do we always keep in mind the objectives of the treatment?

We undergo a treatment because we want to go on living and being well, not for other reasons that don’t concern us. Do we always remember this? Are we always clear that these are the things that we want?

In oncology it is common to repeat that the goals of cancer care, specifically of metastatic cancer, are overall survival (OS) and quality of life (QOL), that is, managing to prolong life time as much as possible and, at the same time, allow people affected by cancer to live in the best possible way. Sometimes these wise intentions are forgotten or substituted by others.

 

For example, sometimes doctors and patients get caught in a battle to defeat cancer, to remove it from the body and end the game at any cost. In metastatic cancer’s case this is surely not possible, at least as far as contemporary medical research has revealed up to now. This endeavour, in addition to being impossible, is after all, pointless. If we go on living and we feel well, what else do we want? Why are we bothered by whether cancer still exists in our body? Is it not enough that it isn’t giving us any problems? The obsession of defeating cancer can lead us to choose aggressive treatments which are little or not at all effective, that make us live badly and don’t prolong our life time but rather, sometimes, shorten it.

Every time we find ourselves choosing a therapy we should remember to carry out a careful and wise cost-benefit analysis, always keeping in mind the two main goals of the treatment: to survive and to live well. For example, Mrs. C. has bladder cancer that has already spread and that, unexpectedly, is responding well to chemotherapy. The physicians who are treating her suggest a surgery to remove her bladder. What benefit will the surgery bring? Is there a real need for this to prevent risks that are threatening her life or to avoid any pain that she is experiencing? Are there well-founded scientific proofs that show that removing the bladder can prolong her life? If so, for how long? With what probability? To what extent can we apply to her case what we know about the potential benefits of this operation to her case? What risks does the operation entail? Does the person who will operate on her carry out enough operations of this kind and are they successful? Is he or she trustworthy? What harm will the operation cause? How will she live without her bladder in the she has left? What are the alternatives? What are their costs and benefits?