Cancer: Why Some Patients Choose Not to Undergo Invasive Medical Treatments

Eveline Gan wrote an interesting article: Treatment for cancer? No thanks, say some patients (28 April 2018, https://www.todayonline.com/singapore/treatment-cancer-no-thanks-say-some-patients). Try to read this article if you have time. For those who don’t want to know more, let me quote some of the salient points that the author said about cancer treatment in Singapore.

  1. Medical advances have made many cancers highly treatable or potentially curable, especially when detected early, but it is not uncommon for doctors to meet patients who refuse standard treatments.
  1. One in five patients might decline treatment when they first see a cancer doctor due to various reasons.
  1. Some patients opt to rely on the power of their faith, while others hold negative views of standard treatments and think they will end up worse off as a result.
  1. While most patients who refuse treatment are in the terminal stages of the disease, this is not always so… some are even in the early stages of cancer.
  1. Although doctors strive to provide the right information to those afflicted with cancer, treatment decisions are highly personal and patients’ wishes should be respected.
  1. Some patients also believe treatment for cancer causes more harm than good, and may prefer to rely on complementary and alternative medicine (CAM).
  1. Patients who rely solely on CAM “may have heard about the harmful side effects of treatment from friends and loved ones who have suffered after undergoing treatment or might have passed away sooner than expected. But this point of view may not be correct as it is often the cancer, not the treatment, that killed them”.
  1. “Usually, the issues patients deal with while on treatment are the toxicities of the drug …. With the newer range of drugs and less toxic side effects, things have improved.”
  1. Nonetheless, it is “not illogical” for some advanced cancer patients to refuse treatment that may prolong life but will not cure them.
  1. “Death comes to all of us, and early open conversations about death, preference of treatment and end-of-life placement should be as automatic and practical as planning for your will.”

Dr. Wachter wrote this article for The New York Times, The Problem With Miracle Cancer Cures, 19 April 2018. He said:

  1. I frequently care for patients with advanced cancer. A majority have already tried some combination of surgery, chemotherapy and radiation. Many have landed back in the hospital because the cancer has returned or spread widely, and left them in intractable pain or struggling to breathe.
  1. Over the past 20 years, evidence has demonstrated that palliative care decreases pain, improves comfort, and in some cases, prolongs life by a few months. In my experience, conversations about turning to it often begin with patients recognizing that curing their cancer is impossible.
  1. A new generation of cancer treatments that have become available in the last few years. Some, called immunotherapy, harness the patient’s own immune system to battle the tumor. Others, known as targeted therapies, block certain molecules that cancers depend on to grow and spread.
  1. Much has been written about the promise of these treatments, as well as their staggering costs — many cost several hundred thousand dollars a year.
  1. A recent analysis estimated that about 15 percent of patients with advanced cancer might benefit from immunotherapy — and it’s all but impossible to determine which patients will be the lucky ones …. researchers noted that most patients will not respond to the new treatments, and it is not yet possible to predict who will benefit.
  1. And in some cases, the side effects are terrible — different from those of chemotherapy but often just as dire.
  2. Sadly, for some patients, a cure will prove elusive. As we continue to chase progress in cancer, let’s be sure that we don’t rob dying patients of a smaller, more subtle miracle: a death with dignity and grace, relatively free from pain and discomfort.

Source: https://www.nytimes.com/2018/04/19/opinion/sunday/problem-miracle-cancer-cures.html?em_pos=small&emc=edit_ty_20180420&nl=opinion-today&nl_art=13&nlid=54459356emc%3Dedit_ty_20180420&ref=headline&te=1

My Comments

There are much truths in what the two authors wrote. Let me add my views to some of the points discussed in their articles.

  1. Meaning of cure.

From a patient’s viewpoint, cure means the cancer is totally removed or killed and it would not recur — i.e., the patient never gets cancer again some years down the road. In other words, after the so called “cure-treatment” you are done with cancer. But is the cancer done with you? Unfortunately, not.

Dr. Wachter wrote, a majority have already tried some combination of surgery, chemotherapy and radiation. Many have landed back in the hospital because the cancer has returned or spread widely.

Yes, that is the reality about cancer treatment. Over the years, hundreds of patients came to us because their cancer recurred. Let me give you a few examples.

My aunty had cervical cancer and she received the standard medical treatment. She was “cured” — i.e., if you define cure as being able to live for 5 years! Twelve years later, the cancer recurred and spread to her lungs. She died.

Nancy (not real name) had breast cancer. She underwent a mastectomy, refused chemotherapy and opted for herbs. After 5 years she believed she was already cured (that is what most doctors would tell their patients) and she stopped following our therapy. Fourteen years later, Nancy came at our centre again and this time in severe pain. The cancer had spread extensively to her bones. She died soon after that.

JS had kidney cancer. After his surgery, he opted for our herbal therapy. He was well for almost 22 years. Then through a “misstep” the cancer recurred and attacked his lung. He died.

MT was an Indonesian lady. She found a thumb-sized lump in her breast. It was cancerous. She underwent a mastectomy. Her doctor said it was an early stage cancer. MT had a 90 percent chance of complete cure with follow up medical treatments. MT totally believed her doctor and did exactly as what was told. She received 6 cycles of chemo and 30 radiation treatments. Then she was prescribed Tamoxifen, which she took for 5 years.

Each year she went back to her doctor in Melaka for routine checkup. At every visit she was told that she was fine. After 5 years, MT was told to stop Tamoxifen because she was already cured.

But barely a year later (i.e., in the 6th year), MT started to have pains in her tail bone and shoulder blade. Then her legs started to hurt. She became breathless. MT returned to her doctor and was told the cancer had recurred extensively to her bones and lungs. How could that be?

MT asked her doctor why the recurrence when she was told just a year ago that she had been cured. The doctor replied,  I do not know why. But don’t blame yourself. It is your fate.  Also the recurrence has nothing to do with what you eat. It is just your fate.

 So, take a deep breath and ask, Is modern day cancer treatment any different from going to the casino? Betting on your luck — how scientific is that? That’s right, read this book, The Big Casino: America’s best cancer doctors share their most powerful stories.

  1. Is there a cure for cancer?

If you are in my position, having come across hundreds of cases like above  — do you believe that cancer can be cured? At CA Care I never use the word “cure” because I don’t think there is such thing as a “permanent cure” up to this day, irrespective of what the medical establishment say. I am more comfortable with the term “healing” not cure.

Doctors sell the notion that with present day scientific medical advances, many cancers are highly treatable or potentially curable, especially when detected early. Yes, to treat is always possible, that is if you have the money to pay for the medical bills.

Over the years, I learned that some patients from Indonesia had to sell their house or land to pay for their medical  treatments. In the US many Americans ended up bankrupt after their cancer treatments.

Times Magazine of 20 February 2013, carried a lengthy article by Steven Brill: Bitter Pill – Why Medical Bills Are Killing Us.

Treating cancer is a huge and highly profitable money making industry. Besides the drugs, staying in the hospital is not cheap! So, there is always treatment for your cancer!

To add salt to the wound, what if someone comes out with an idea that finding a cure for cancer is not a good business model. Read this article, Is curing patients a sustainable business model?

  1. Don’t worry we have a lot of expensive “magic” drugs!

Almost all of the patients who came to CA Care for help had underwent medical treatments for their cancers. And these treatments failed to cure them. Let me just give you just one example from the hundreds of emails I received.

Email: 12 March 2018:  Dear Dr Chris Teo,

My name is Alice (not real name) from Singapore. I’m recommended by V, who used to have tongue cancer. 

My mum was diagnosed with advanced stage rectum cancer spread to the liver in May 2017. After going through chemo for 9 months, recently her oncologist has told us that her liver has worsen and even chemo won’t help. 

Alice said on diagnosis the family was told that her mother needed chemo immediately otherwise she would die within a few weeks. With no way else to turn to, she had chemo. After 9 months of failed attempt, the oncologist offered more treatment, now using a “wonder drug” that cost SGD 9,000 per month! Good for the family, but the honest oncologist said, But I would not recommend it because of the severe side effects!

As I was writing this article, a 68-year-old man walked into our centre. He had prostate cancer and had been on hormonal therapy. His PSA was initially at 254. With Lucrin injection the PSA dropped to about 20. Great, wonder drug, right?

Hang on, it is not time to celebrate yet. Soon afterwards the PSA started to increase to 80. Well, this is to be expected and nothing unusual. The doctor changed drug. The patient was put on a “magic” drug called abitraterone or Zytiga. This cost RM 12,000 per month. Can Zytiga cure him? After 6 months on Zytiga, his PSA dropped from 80 to 13. Time to celebrate? Not yet! The PSA level of 13 lasted for only 2 months, then it started to increase to 32 within three months. The doctor suggested intravenous chemotherapy!

All in all, this patient spent a total of about RM132,000 for 11 months of Zytiga. What did he get in return for this expensive adventure?

One oncologist told her patient, Don’t worry, in Singapore we have a lot of drugs for your cancer! Well, if you are willing to fork out something like  RM 5,000 to RM 20,000 per month surely there are many drugs to try out. But can these drugs cure you? Not likely but they may probably make you live longer by a few more weeks. Do you want that?

Michael Gearin-Tosh (in Living Proof – a medical mutiny) asked, why treat when you cannot cure? This professor from Oxford was diagnosed with myeloma and was asked to undergo chemotherapy. The doctors gave him less than a year to live. He rejected chemotherapy and opted for the unconventional self-treatment. He went on to live for another 10 years and died at the age of 65.

  1. Early detection can potentially cure your cancer?

This is the mantra of today’s modern medicine — cancer is potentially curable if detected early! Yes, I tend to agree with this but for most patients their cancers were often discovered too late — the cancer had already spread, at Stage 3 or 4. In such case, potential cure is questionable.

In fact, early detection is a two-edge sword. It may help or it may make things worse. This is a big subject to discuss. If you wish to know more, read this article, Overdiagnosis and Pseudodisease as a starter. Or try this, Is early detection of disease always an advantage?

  1. One of five patients declined standard medical treatment – why?

In Eveline Gan’s article, we learned that one in five patients might decline the standard medical treatment for their cancer. It’s rather surprising for this to happen in Singapore!

So why don’t patients want to go for medical treatments? I am sorry I cannot answer this question. It must be the patient himself/herself who should answer this question.

Some of the reasons laid out in Eveline’s article are:

  1. Some patients opt to rely on the power of their religious belief.
  1. Some others hold negative views of standard treatments and think they will end up worse off as a result — the treatment causes more harm than good. These patients “may have heard about the harmful side effects of treatment from friends and loved ones who have suffered after undergoing treatment or might have passed away sooner than expected.”
  1. Most people know that cancer treatments are toxic! Because of that some patients prefer the non-toxic or non-invasive alternative therapies.

This is where CA Care role fits in here — to provide you  with an alternative, if you so decide not to follow the medical path. My advice to all patients: Learn all you can from the mistakes of others. You don’t have time to make them all yourself.

After coming to us — i.e., taking the unconventional path to your healing — most patients want to know if our therapy can cure their cancers. We tell you clearly, honestly and sincerely — No, we cannot cure you. Because we believe no one on earth can cure any cancer!

  1. Truthful or biased and skewed opinion?

At CA Care we tell patients to be wise and don’t just depend or believe entirely what the “experts” say. Again this is just common sense. We are all humans — we all have our opinions and preferences. We tend to see things only from our own perspectives based of our own experiences and training.

In her article, Eveline wrote, Although doctors strive to provide the right information to those afflicted with cancer, treatment decisions are highly personal and patients’ wishes should be respected. Cheers! This indeed should be a noble principle of all healers.

Unfortunately it is easy said than done! More often than not, patients were “threaten” under the guise of giving truthful professional advice. One surgeon told a lady with breast cancer — if you don’t go for chemo after surgery, I am not going to be responsible for your well being anymore! In the case of Alice above, the doctor warned that her mother needed to do chemo immediately otherwise she would die within a few weeks. May be just advice was given in “good faith” but was it the real truth?

GK had melanoma in 2007. This rare cancer had spread to her lungs — i.e., Stage 4. Without immediate radiation treatment she would die soon. GK refused to follow her doctor’s advice and came to seek our help. It is now 2018, GK is still healthy and very much alive!

In April 2012, Heny coughed out blood. She was later diagnosed with synovial sarcoma. There was a 4.8 x 5.1 cm   cm mass in her right lung, and a 4.2 x 5.6 cm mass in her left lung. She was told to undergo chemotherapy. Without chemo she would die within 6 months. With chemotherapy she would live for another 2 years. Heny refused chemo and came to seek our help. Just two weeks ago, (in April 2018) Heny came to our centre, very much alive!

Elly from Melbourne had endometrial cancer in November 2008. She had an operation and was later told to go for follow up chemotherapy and radiotherapy. The doctor told Ella that without these treatments she would probably die within 3 months, but with chemo and radiation she would probably last another 2 and a half years. Ella told her doctor, I will prove you wrong! It is now 2018 (almost 10 years), Ella is still alive and healthy!

I can go on and on with such stories. But, I think my message is already clear. Patients and those around them need to cast the net wider. There are more to know and learn about cancer treatments way beyond what you find in the hospital.

Is CA Care Therapy scientifically proven? Although I am a scientist, I think the application of simple common sense is far more important than trying to practise science!

In his book, The Laws of Medicine, Dr. Siddhartha Mukherjee wrote, The laws of medicine are really the laws of uncertainty, imprecision and incompleteness … They are laws of imperfection.

How many patients know this law of uncertainty and imperfection when they go and see their doctors? More often they are told medicine is scientifically proven! It is sad for me to say this — how many people know or realize that most of the findings published in the medical journals are biased and false?

On the other side of the fence are the alternative healers. Many think of them as just quacks — fly by night, snake oil peddlers!

CA Care has been around for more than two decades and we have helped thousands of cancer patients. Go to our website, https://cancercaremalaysia.com/cancer-story/ and read for yourself all those cases we documented. Common sense will tell you that if we are not effective, we would not last that long and we would not be able to write those case studies.

  1. Death with dignity.

Death is a taboo subject for many patients. But in CA Care, I spoke to patients freely about death. All of us have to die one day. Birth ends with death. Accept that death is a certainty which no one can escape

But you don’t have to die yet after being diagnosed with cancer. I have learned this form my patients — sometimes their spouses, who did not have cancer, die before them!

At CA Care we teach patients to live one day at a time, and learn how to accept things with grace. Even if we cannot cure cancer, it is okay. No use fighting it because we cannot win the war!  But remember this, When we are still alive, it is important that we live a happy, pain-free life. If you can eat, can sleep, can move around freely — what else do you want? Learn to appreciate and be grateful for every blessing that come your way! Unfortunately, some cancer patients cannot see that — they just want to be cured and then quickly go back to their old lifestyle again!

Yes, it is “not illogical” for some advanced cancer patients to refuse treatment that may prolong life but will not cure them. I fully agree. This is just good common sense. Dr. Wachter also come to a similar conclusion, sadly, for some patients, a cure will prove elusive. As we continue to chase progress in cancer, let’s be sure that we don’t rob dying patients of a smaller, more subtle miracle: a death with dignity and grace, relatively free from pain and discomfort.

Let me end this discussion by sharing with you an email which I just received a few hours ago. This email was written by a daughter of our patient who had nose cancer (NPC). He refused the standard medical treatments — radiation and chemo. It has been some years since he came to see us and was on our CA Care Therapy.

Hello Doc Chris,

I wish this email makes your day more fulfilled and accomplished.

My father received the herbs a week ago. Prior to that, his swollen neck was really huge. During my holiday there (in the Philippines), we had beach outing and outside activities most of the time. After that, he complained of severe pain at night especially right after when he went swimming at the pool for more than 2 hours. It must be from the chlorine and the hot weather. 

His hearings are getting worse every day that I had to go to the ENT clinic to get hearing aids for him. Unfortunately, they are very expensive … so we had to wait till we can save up some cash. 

Yesterday, my mom sent me a message that after taking the new herb (SAP) for a week now, his hearings started to come back. He said that he could even hear the running water from far as if he was wearing a hearing aid. His swollen neck is getting smaller as well.

Thank you for introducing this medicine. I guess if this continues, we don’t need hearing aids anymore. I’m always grateful to you and your wife’s hard work and genuine care for all your patients.

Sincerely,  Jazz 

I wish those involved with cancer patients can learn something from this discussion!

 

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