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Don't Push Patient Into Radiation Therapy, Oncologist Says


  11:22:21 am, by MedBen5   , 321 words,  
Categories: Wellness, Health Plan Management

Don't Push Patient Into Radiation Therapy, Oncologist Says

Some thoughts on giving patients a greater degree of autonomy in decision-making, from Miranda Fielding, a radiation oncologist:

“Last week I saw a new patient, a genuinely lovely and intelligent woman of 70 years, who was diagnosed with breast cancer five years ago. She had had a lumpectomy and a sentinel node dissection, and fortunately her cancer was found at Stage I. But when it came to completing her breast cancer treatment, which included radiation to the breast followed by anti-estrogen hormonal therapy, she refused, despite the fact that her surgeon and medical oncologist argued strongly that she was depriving herself of standard-of-care management. She stated back then, and again last week, ‘I will not do anything which will affect my quality of life.’ When she recurred, the tumor came back in the axillary lymph nodes, and the surgeon had a difficult time removing the nodes due to her previous axillary surgery, and microscopic disease was certainly left behind.

“To have taken more tissue would have been to risk nerve damage and certain lymphedema. So she was sent to me for radiation. And, just like five years ago, despite the fact that we covered all side effects, risks and benefits during our 90 minute consultation, and she agreed to treatment, she now is once again questioning what the radiation may do to her quality of life. Yesterday evening I called her on the phone at her request, to attempt to allay some of her fears. I felt myself slipping into my old habits of persuasion, and I stopped. I said to my patient, ‘You can have five weeks of fairly simple treatment now, or you can wait until you have another recurrence, and require additional surgery and a higher dose of radiation. Which quality of life is worse? Which will give you greater piece of mind? You decide. Don’t let me talk you into it.’”


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