Wednesday, July 11, 2012

July 11, 2012 – Would You Want to Know?

An article in the July 9 New York Times (Gina Kolata, “A Life-Death Predictor Adds to a Cancer’s Strain”) lays out a grim but philosophically-fascinating scenario.

Imagine you have advanced cancer of the eye. If the tumor has grown large, you’ll very likely lose the eye, which is bad enough – but that’s not all.  A new option for genetic testing of your tumor reveals, with a very high degree of accuracy, which of two subtypes of ocular melanoma you have. Half of all patients have the first type, and are likely to recover completely. Those unfortunate ones who fall into the other half face a 70-80% likelihood they’ll be dead in five years, from metastases to the liver.  This second type of eye cancer is incurable.

According to the Times article, there’s some debate in the medical community over whether doctors ought to offer this testing option at all.  Most patients, it seems, have said they would rather not know if they have an incurable disease. And for those who do, learning of the incurable nature of their disorder – so soon after the initial diagnosis – could very well send them into an emotional tailspin from which they may never recover.

“Why would you want that information when we don’t have anything we can do for you?” one oncologist asked. “That is the fundamental question that has caused people to pause.”

It’s not that the test is medically useless. Some doctors point out that, if they can discover the cancer as soon as it jumps to the liver, they may be able to control its spread for a while. Even after it moves on to the lungs or bones, there are further treatments that can slow its inevitable progress, buying even more time and sparing the patient some pain that would come with a faster-moving cancer.

“Would you want a horrible death that is relatively short,” one doctor asks, “or a death that is slower?”

Of course, those who agree to the test and find out they have the curable variety are much relieved, and rejoice at the good news.

I think I'd want to know.  I’d want to have as much time as possible to scratch a few more items off my bucket list.

So, what do you think?  Would you want to know?


Joan Calvin said...

What aggravated most was the idea that the docs would make the decision about whether I would know or not. Not me. Are we back to the 50s when doctors "knew" best.

I think I'd want to know. My constant anxiety about my ovarian cancer has finally after a bit more than four years calmed down.

Who do they think they are--God?

brooke r. said...

um yeah. I would wanna know what kind of cancer I have. Pragmatically that impacts long term planning, it also impacts how I would approach my treatment, etc. Of course, I am the type of person who goes and reads research articles about different treatments for friends with cancer. I can understand the stats and look up things I don't understand. So, I'd want to know so I can inform myself through Dr. Google Scholar.

If I'm going to have the privilege of this knowledge, I should use it. My doctor should also give me the opportunity to use it. If my doctor doesn't, then I'm seeing the wrong doctor.

Anonymous said...

Some of us with other types of cancer get told that kind of bad news right away already. "It is cancer, it is stage IV, it is not curable," right out of anesthesia. And it only takes a few minutes with google to figure out that the survival rate bottoms out at five years. Personally, I have found it easier to cope when I know where the cancer is, not when I'm waiting for it to come out of hiding again. Right now, I know exactly where it is, and pretty much what time is left (from my oncologist, not google). And I am calmer than I have been any time in the last four and half years.