When Cure Isn’t What It’s Supposed to Look Like

In oncology, we strive for cure and short of that, we strive for stability. In some instances, particularly with recurrent disease, cure is rare, and the process of curative treatment can be quite extreme (for example, bone marrow transplantation for recurrent lymphoma, with the real risk of graft versus host disease substantial and, in its most extreme, debilitating). But in solid tumor oncology (for the most part), we have been driven toward less-toxic treatments, less-complicated regimens, while continuing to strive for better survival.

Cancer as a Chronic Disease

I remember as a kid, my grandmother would spend time at our breakfast table reading the newspaper. Not cover to cover, mind you—she seemed to always focus her attention on the obituaries. Sometimes she would look up and tell anyone sitting around her about the death of someone near her age, or sometimes, someone very young. It was the first time I remember hearing how someone “lost the fight to cancer.” It is something I have heard many times since, and it continues to bother me. I’ve written before how the war analogy implies winners and losers, but even more than that, the analogy assumes only two outcomes: remission or death. No middle ground. And today more than ever, nothing is further from reality.

Being Human

When I was a resident, my colleagues chided me for wanting to be an oncologist. Back then (and it pains me to be old enough to use that phrase, by the way), oncology was thought of as a field of futility. We administered toxic drugs to sick patients, who far more often than not would die of the cancer or from our treatments. The disease was cruel, and to many, oncologists didn’t really help­; they only prolonged suffering. Of course, I never saw oncology in that light­—I came in to this field to help us do better. To me, being an oncologist would be a privilege­—to help people through such a difficult diagnosis, and to stay with them through whatever happened next. It was primary care at its most extreme.

What’s in a Word?

I’ve written in the past about how words are powerful—that they can have multiple meanings, and how they can change depending on context. I am often reminded about how true that is in every day oncology practice, especially when it comes to meeting new patients. Some are diagnosed with cancers that carry a relatively good prognosis, in which case there is reason for an optimistic outlook and of “curative” treatment. Others have more advanced disease or a poorer prognosis, in which case I tend to be more cautious with the words I choose: “remission,” “stability,” “progression free,” yes, but “cure” is a word I rarely use.