Boundaries: The Limits of Modern Medicine in Oncology

For those of us who have been affected by cancer, we know that this illness does not discriminate. It affects everybody just the same. For far too many, a crossroads occurs during treatment regarding the decision to keep going or to stop. We count on medical professionals for guidance, but finding the answer is still not easy. It seems that there are always promising treatments just over the horizon. Sadly, although curative treatments are often spoken of, for late-stage and terminally ill patients, they are unfortunately not a reality.

Miss Diana was in her 70s and had battled breast cancer for the last 18 years. Her viewpoint was that she had been given plenty of time to live life. Her only regret was the pain that her loss would cause to those she loved most, namely her partner of 53 years, Coco. Though she would have loved more time, she chose to end treatments instead of facing more of the numerous complications that came with chronic cancer. She passed away peacefully 13 days shy of her birthday.

The youngest was Joey, a little boy who stole my heart. He was a brilliant young child who barely had the chance to live. He spent far too much time in hospital rooms that he hated instead of the Lego-filled bedroom that made him smile so brightly. He had Ewing’s sarcoma and fought valiantly for four long years. But cancer eventually stole the brave young boy who was just 8 years old.

Then there is Anthony, who I met during my sister’s bone marrow transplant. At 19, he was a basketball prodigy when diagnosed with leukemia. He has had a rough road, gaining immediate remission then relapsing six months later. He then went through an allogeneic transplant, only to suffer graft-versus-host disease (GVHD) after three weeks. The rejection continues to mean a lot of time in hospitals and the inability to eat food, something that he loves almost more than oxygen.

I also visited Bethany. At the age of 21, she was diagnosed with stage 2 classical Hodgkin’s lymphoma. The following week, she began what would be 12 treatments of ABVD chemotherapy. After round eight, a PET/CT showed a full remission, and the final four doses were given as a precaution. Her chance of a relapse was stated to be less than 10 percent. Just shy of three months cancer-free, a sports injury changed everything.

She was playing softball and dislocated her left knee. A trip to the emergency room revealed a tumor behind the knee cap that led to the dislocation. Another scan was given, and her relapse was worse than her original diagnosis. Cancer had metastasized to her bone marrow, right lung, left kidney, heart and spinal fluid. She was told that there were options, but that remission was simply not attainable this time.

Doctors began to offer treatments, including chemo. But she knew that would mean nausea and time spent in doctor offices. They offered radiation, but the pain meant time in bed and the inability to run around with her niece, Naveah. A transplant consult took place, but she would need to cleanse her body of cancer and find a donor heart. That also meant moving to Vancouver, because the treatments and transplant could not be done within the states. In the end, she had one simple question: “If I do it, how much more time will I have?” The answer was that nothing was a guarantee and complications could mean even less time.

Of her family, her 26-year-old sister and 2-year-old niece are the only ones who live in the United States. The majority of her family lives in Paraguay. Her sister stated her wish that Bethany would continue treatments in an effort to gain time and to see her nephew born in October, if for no other reason. Instead, Bethany began consults with palliative care to finish making all of her long-term decisions. She decided that the remainder of her life should be spent outside of clinical settings and with family.

A recent study presented at the Annual Meeting of the American Society of Clinical Oncology revealed that many patients continue with treatments that are more harmful than helpful towards the end of their lives. Why the numbers are so high is debated within the medical community. Nonetheless, patients and families in that position face difficult choices. Do they push for life-prolonging treatments or do they choose a palliative path that may allow for a better quality at the end of life?

For Miss Diana, the question was answered when her organs began to fail as the result of treatments she had endured years earlier. Joey's family discontinued treatments in hopes of a peaceful passing at home in Texas. Sadly, Joey passed shortly after an emergency surgery to relieve swelling in his brain from the sarcoma metastasizing. Anthony had the choice made for him because of complications that prevented his body from sustaining any further treatment options that may exist.

Bethany did not stop treatments and began to live again, just as she did with the last remission. She played sports, chased after Naveah, shared spa days with her big sister and blew people away with her cello performances. Even with chronic pain, she made the choice to get out of bed each and every day. Her goal was to live life to the fullest and spend time soaking up all that this wonderful world has to offer.

She, her sister and her niece boarded a flight to Paraguay for a trip home to see all of their family. Knowing that she may not have much time left, she wanted to make memories that she hoped would last her family their whole lifetime.

As somebody who has spent a long time in clinical settings as my sister battled cancer, I have come to know many who are on a journey like ours. Many patients pass through the same doors that we do, and they all have their own stories to tell, some are happy and some will end far too soon. None are ever easy and all of them are unique. Having been in the position of thinking there was nothing left, and watching others go through the same, I think one of the hardest parts about cancer is knowing that even with all that modern medicine has to offer, limitations still exist in the field of oncology.

*After this article was written, Bethany passed away surrounded by family, friends and her beloved dog, Talia, on July 13, 2016 at the age of 23.