When alternatives hinder treatment

There has been a great deal of interest regarding alternative lifestyles and healing after the media published the story of a young boy with leukemia.

This was a unique case as it dealt with a minor, whose divorced parents had differing views on whether to allow the doctors to administer chemotherapy.

The case was also special because the attending doctors said there was an 80 per cent chance that the boy could be cured with chemotherapy, and judged that the disease would be fatal without treatment.

The doctors applied for a court judgment and the court’s decision was for the child to undergo chemotherapy and be placed under the custody and care of the father.

All too often, I see patients who refuse conventional treatment – surgery, radiotherapy or chemotherapy – despite having cancers which are treatable and potentially curable.

They skip follow-up visits and return often with the disease in very advanced stages which are mostly incurable.

Just this week, I saw a 59-year-old woman who has a 7cm cancer in her left breast. The tumour from the breast had broken through the skin and formed a cauliflower-like mass. It was a weeping wound, infected and foul-smelling.

Her left arm was swollen with fluid because the cancer had already spread to the lymph nodes in her armpit and neck. The cancer-affected lymph nodes had blocked the flow of the lymphatic fluid, causing the arm to be swollen.

As I probed into the history of her illness, she told me that she first noted a small 2cm lump in her left breast about a year ago. At that time, she saw a doctor, who suspected that it was breast cancer.

She was advised to undergo a biopsy of the breast lump.

She refused and sought alternative treatment, which consisted of changing to a strictly organic diet as well as treatment with herbal medicine.

She went for hyperbaric oxygen therapy, which involves placing a person in a pressurised chamber filled with oxygen. This has no value in the treatment of cancer. She also bought a special electromagnetic jacket, which came with a guarantee that the cancer would be cured.

For an entire year, she watched the tumour get bigger and bigger until two months ago, when the tumour broke through the skin and formed a visible grey cauliflower mass.

In much pain and discomfort, she finally accepted her friends’ advice to see me for evaluation and treatment.

Her story is by no means unique. Most doctors would have had similar encounters.

I often feel anxious and concerned when I see patients who have potentially curable cancers opt for alternative therapies, which I know are not going to work.

These are not young boys whom the courts can order to act sensibly, but are adults who have every right to choose what to do with their bodies.

When I first returned from my oncology fellowship in 1990, I was dead against patients taking traditional Chinese medicine (TCM), the main form of alternative therapy in Singapore.

However, I have mellowed through the years and have reached a position of compromise. While I still caution patients on the potential interactions and side effects, I have come to accept that TCM is here to stay.

Rather than force patients to choose between conventional treatment and TCM, I stress the importance of compliance to proven medical treatment and allow them the complementary use of TCM.

My only request is for them to delay TCM until the first course of treatment, so I can tell if they are reacting to the treatment or TCM.

Persuading patients to undergo conventional treatment takes time. The first and hardest step is to get a patient to ‘open up’ so that I can understand his fears. There is always a better chance of success if the patient is willing to talk about why he does not want recommended therapies, be it surgery, chemotherapy or radiotherapy.

The second step is to convince the patient that the decision is supported by medical evidence, rather than my personal opinion.

As such, I often give him names of other doctors whom he can see for a second or third opinion.

I would always include some names of doctors from the restructured hospitals for him to choose from. As a private doctor, I am aware of the unspoken but very reasonable suspicion that I am recommending him a course of treatment for personal gain.

Last, but not least, I try to get him to meet patients who have had similar conditions and gone through treatment successfully.

In my group practice, we have formed a cancer support group called CanFriends, which is a non-profit part of our work.

The support group comprises cancer patients and their family or friends who volunteer their time to help the practice’s cancer patients. We also have a team of medical counsellors to support them.

Patients have the right to decide what treatment they want. And that means that we have to respect their wishes to decline treatment even though we know it is in their best interest.

This is frustrating and sometimes causes great angst when I know the outcome can be dire.

On the other hand, being able to help even one of these ‘difficult’ patients brings much joy and satisfaction.

This article first appeared in “Mind Your Body”, a Straits Times Supplement.

POSTED IN Cancer Treatments
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