Cleaveland: When malignant disease cannot be cured

FILE - In this May 25, 2017 file photo, chemotherapy drugs are administered to a patient at a hospital in Chapel Hill, N.C. The U.S. cancer death rate has been falling between 1991 and 2016, and so far there’s little sign the decline is slowing, according to a report released on Tuesday, Jan. 8, 2019. (AP Photo/Gerry Broome)
FILE - In this May 25, 2017 file photo, chemotherapy drugs are administered to a patient at a hospital in Chapel Hill, N.C. The U.S. cancer death rate has been falling between 1991 and 2016, and so far there’s little sign the decline is slowing, according to a report released on Tuesday, Jan. 8, 2019. (AP Photo/Gerry Broome)

Advances in diagnosis and treatment of malignant diseases proceed at a dizzying pace. Diseases that were progressive and fatal a few years ago may now be eradicated or arrested. Newer medications precisely target malignant cells with less injury to normal tissue. Labs produce antibodies that attach to receptors on cancerous cells, killing them. A patient's white cells can be reprogrammed to attack leukemic cells. Science related to cancer no longer marches ahead; it sprints.

Progress comes at a high cost. Years of basic and applied scientific research precede the discovery and testing of a new therapy. Many investigations lead to dead-ends. Once developed and clinically tested for safety and efficacy, a new therapy may only apply to a few thousand patients who are affected by a specific, malignant disease. A breakthrough in therapy may be rapidly replaced by the next discovery.

photo Clif Cleaveland

For many patients, therapy will never end. Costs and complex side-effects will be continuing concerns in their futures. Some therapies may stimulate development of new cancers in other organs. Depending upon the malignancy and the available medications, the cost of a year's therapy for an individual patient may exceed tens or hundreds of thousands of dollars. Even with Medicare or other health insurance, co-payments and deductibles can drain a family's financial reserves and create tough choices in planning for the future, for example, saving for children's educations, retirement planning or paying off other debts.

For patients with limited financial resources, oncology centers can arrange either free therapy or assistance with co-payments. Paperwork related to this assistance can be daunting.

The social costs of cancer treatment become apparent at an outpatient treatment center where statistics are replaced by individuals with names, hopes, and fears:

Patients gather at their appointed hour in the clinic's infusion center. A dozen or more men and women take their seats in recliners. Each is usually accompanied by a friend or family member. They await lab results that will determine if the day's precisely determined dose of chemotherapy or biologic therapy can be administered. Some may receive an injection in their abdominal wall or through a port that provides access to a vein and quickly depart. Other patients require an intravenous infusion of several hours' duration. A patient may need a blood transfusion. They may return daily, weekly or monthly, depending upon the stage of their illness and the treatment's protocol. Their diagnoses include metastatic lung, prostate and breast cancer, lymphomas, acute leukemias and multiple myeloma. They may have lived with their malignancies for months or years. Patients come and go throughout the day.

Some of the patients have had previous surgery, radiation and medical therapy. For patients with leukemias and other blood-system malignancies the infusion center may represent their initial treatment or the site for addressing a relapse from earlier therapy.

Infrequently, a bell is struck to indicate a patient's completion of a course of therapy. He or she will require close follow-up for years.

In the center, hope is mixed with apprehension. Greetings or nods are exchanged among patients. Conversations are interspersed with intervals of companionable silence. Some patients sleep throughout their treatment.

On one memorable occasion, a Valentine's Day, a young harpist provides an hour of beautiful music to lift spirits.

The oncologist at the center evaluates new and returning patients in adjacent exam rooms and addresses problems that arise among those receiving treatment. Nurses move among the patients, adjusting rates of IV flow, hanging bags of additional medications, and attending to the recurring beeps emanating from infusion pumps. The clinical team never overlook the other needs of the individual, who may be sad or afraid or exhausted.

In 1925, famed Harvard physician, Francis W. Peabody wrote: " ... for the secret of the care of the patient is in caring for the patient." This is a guiding principle for the center.

Discoveries in cancer therapy are publicized and praised. Meanwhile, staff at the clinic exert their expertise and compassion continuously. These caregivers are the infantry in a never-ending battle.

Contact Clif Cleaveland at ccleaveland@timesfreepress.com.

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