Treatment Questions

This is something I copied from a message on news:sci.med.diseases.cancer:

Patients with cancer have to make very significant decisions about which, if any, treatment to take. The aims of treatment are often rather “woolly”, and “success” is measured in things like reduced tumour markers or decreased size of abnormalities on CT scans. These things MAY be associated with improved outcome, but not necessarily so. The fact is that although technically treatments are complex and require skilled supervision, the decision to embark on a treatment should be, if not simple, at least amenable to being assessed logically and objectively.

This is the way I get my patients to look at the cost-benefit analysis when deciding on a course of treatment I have suggested would be right for them. The “algorithm” isn’t specific to cancer, or even orthodox medicine, but most patients find it useful, and I hope some people on this NG may, too.

Does the cancer I have pose a threat to my life or health? If the answer to this is “No”, then you probably shouldn’t be taking treatment. If yes, consider treatment by going to the next question.

Does the suggested treatment have any realistic chance of curing me, and if so, are the side-effects and risks acceptable to me? If the answer to either part of this is “No”, then you probably shouldn’t be taking treatment. Otherwise go to the next question.

Although the treatment stands no real chance of curing me, does it stand a realistic chance of extending my survival by some worthwhile amount, and are the side-effects/risks acceptable? If the answer to either part of this is “No”, then you probably shouldn’t be taking treatment. Otherwise go to the next question.

Although the treatment stands no real chance of curing me, or of extending my survival, does it stand a realistic chance of improving my quality of life, after I have taken into account the side-effect/risks? If “Yes”, go for it. If the answer is “No”, then you probably shouldn’t take the treatment.

A patient’s quality of life is not measured by PSA levels, but by how they feel and how well they are able to carry on with their life. Improvement in a patient’s quality of life is not measured by whether the oesophageal cancer looks smaller on the CT scan, but whether the patient can swallow better. A patient with bone pain is not better because the bone scan is better, but because the pain is better.

Think about it.

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