Metastatic Colon Cancer. Part 2:  Lessons We Can Learn from Linda’s Failure

The doctors went to war with Linda’s cancer. All Interested Parties involved won the game. Linda was the only unfortunate loser or victim. Let us not blame anybody for that is the way the world operates!

When Linda’s daughter came to consult me, she brought a pile of documents. It took me more than a whole day to sort them out and figure out what was going on. There are many lessons we (YOU and ME) can learn from Linda’s unfortunately experience.

First, let me pose one question:

• If you have a similar problem like Linda, would you take the same route – go through the same process? Do exactly what she did?

My guess is most patients would opt to take the same road! After all Linda went to one of the best hospitals in the country. The doctors were supposed to be good and competent, etc., etc. Some people would say: What other choice do I have? I can’t go to the herbalists or alternative practitioners. I can’t trust them. They may just turn out to be quacks who are only after my money. Medical treatment is the best choice.

Sure, I understand you. I don’t wish to challenge your belief. I always remind myself: Make your own decision and bear the consequences of that decision. It is your body and your life.

1. When talking to Linda’s daughter, the impression I got was that the family was ignorant. They just followed whatever the doctors advised them. They followed the easy and simple belief that doctors know best. There is no need to ask too many questions. Why make life more difficult? No need to think, no need to ask questions – after all doctors can solve all of our medical problems. 

I posed these questions to Linda’s daughter.

• Before undergoing the surgery in Hospital A, did you ask the surgeon if the procedure is going to cure your mother? Her reply: Doctor said there is a 60% chance.

• Before undergoing chemotherapy after the surgery, did you ask the oncologist if chemo is going to cure your mother? Same answer: There is a 60% chance.

• After 13 cycles of chemotherapy failed and the cancer recurred, did you ask the oncologist why the treatment failed? Her reply: The oncologist said continue with the chemotherapy! Yes. Linda did exactly that except that she shifted to Hospital B for more of the same treatment!

• Pre-surgery treatment. Linda was given radiation and TS One before undergoing surgery. This seems to be the standard protocol when a patient presented with a big tumour. Is this a good procedure? Well, it all depends on who answers this question! For the 25 cycles of radiation and a month supply of TS One, the family had to spend RM40,000.

Did the pre-surgery treatment shrink the tumour? Yes, but by just a bit only. Did it make any difference? I cannot answer that. But one thing is of great concern. According to Linda’s daughter, her mother suffered from the treatment.

• Looking at the whole picture. Did the pre-surgery chemo-radiation and subsequentsurgery cure Linda? The answer is NO. Linda had to go for another 13 cycles of chemotherapy. Fortunately, Linda did not suffer any serious side effects.

Did chemotherapy cure Linda? Again, the answer is NO. The tumour grew bigger! What did the doctor say? The oncologist did not admit defeat! Go for more chemotherapy! This means, go on fighting and fighting – when will that stop?

Linda decided to go to another doctor in another hospital. So, all in all the whole treatment in Hospital A is a failure.

• The oncologist said do more chemo. But whatever for? What do you expect to achieve? Thus far, one achievement was that the whole health insurance coverage was wiped out – about RM150,000 gone!

Let us look at what Linda received for her treatment.

• TS-One – oral chemo for a month.
• Xeloda + oxaliplatin – four cycles.
• Avastin + Xeloda + irinotecan – nine cycles.
• Avastin + oxaliplatin – one cycle.

The first three regimen of chemo failed. Do you think the fourth regimen is going to do any good? Linda had already received Avastin and oxaliplatin before. Does it make sense at all to give her the same drugs again? I understand it is just a different combinations.

FALSE IMPRESSION OF SUCCESS

• When Linda was started on chemo-radiation before the surgery, the tumour did shrink. This gave everyone a good feeling that everything is going to be okay, right? The treatment worked. The oncologist was great! Bravo.

• The surgery was done and it was a success! Another good feeling. Great surgeon! But some months down the road, the surgery turned out to be a failure. The cancer recurred and Linda had to undergo a second surgery in another hospital.

• The first round of chemotherapy with Xeloda + oxaliplatin was a failure. No problems, change drugs and try again.

• The drugs for the second round of chemo were: Avastin + Xeloda + irinotecan. The initial response to this new drug combination was great! Many tumours shrunk and some even disappeared. Linda did not suffer   serious side effects. It appeared that Linda was on the right track. Everyone was probably hoping that the tumours will all eventually disappear. Let’s chase the rainbow – that “pot of gold” is within reach.

• Unfortunately, it was not a happy ending. The tumour that shrunk earlier grew back again! This time bigger in size.

I can clearly say this. Such above experience is not uncommon. Over the years, I have cases after cases of similar false impression of success.