Alternative oncology versus oncology

[SidDithers]

http://scienceblogs.com/insolence/2015/03/04/alternative-oncology-versus-oncology/

I hadn’t planned on discussing the death of Jess Ainscough again, figuring two posts in a row were enough for now, barring new information. Besides, I was getting a little tired of the seemingly unending stream of her fans castigating me for being “insensitive” and saying it was “too soon” to discuss her death and wasn’t sure I wanted to reawaken that discussion, which is only now finally dying down. This was a young Australian woman who was unfortunate enough to be diagnosed with a rare form of sarcoma at age 22 for which the only known treatment with a reasonable chance of providing her long term survival was a radical amputation of her right arm. Her doctors tried isolated limb perfusion with chemotherapy, which made the tumors appear to disappear, but unfortunately they recurred after a year, which led back to the recommendation for a radical amputation, probably a procedure known as a forequarter amputation. It was at this point that Ainscough rejected conventional medicine to treat her cancer, embraced the quackery known as Gerson therapy, and became the Wellness Warrior, a popular advocate for “natural” living and the Gerson protocol. All the while, her tumor kept slowly progressing, and, less than a week ago, it finally claimed her life after nearly seven years.

Then I saw a column by an oncologist named Ranjana Srivastava in The Guardian‘s “Comment Is Free” entitled What do doctors say to ‘alternative therapists’ when a patient dies? Nothing. We never talk. (OK, actually, some commenters referenced it, and a couple of my raders sent me the link.) It’s an excellent discussion of a topic we don’t often think about. Dr. Srivastava uses Jess Ainscough’s case as a jumping-off point to discuss the very uncomfortable issues that come up whenever a science-based practitioner “shares” a patient with an alternative practitioner.

I might be a cancer surgeon, but, fortunately, I rarely have to deal with this issue because the treatment course surgeons offer tends to be a more immediate, shorter-term treatment. This is certainly true for breast surgery, which is mostly what I do, although for certain GI and other forms of surgery a patient can be seeing the surgeon for many months or even years. In any case, I usually see the patient, determine the operation she needs, do the operation, and then follow the patient until she’s done with all her immediate adjuvant treatment, usually between six and twelve months. Alternatively, if in my judgment the patient needs neoadjuvant chemotherapy to shrink her tumor before surgery, I will send her to the medical oncologist and see her again near the end of her chemotherapy to schedule surgery. It tends to be the medical oncologist who follows the patient for years, and during the chemotherapy phase (if chemotherapy is needed, which is isn’t always for breast cancer) might see the patient quite often over the course of the five months or so that it takes to administer standard chemotherapy for breast cancer.

They are the ones for whom Dr. Srivastava’s article will hit home, because they are the ones who have to deal with such things far more often than a surgeon like myself will. After all, usually, if the patient is willing to undergo surgery, she won’t be pursuing a lot of the woo described in this article. Alternatively, I tend to see the patients at the end stage of having pursued quackery instead of effective treatment, when they have huge fungating cancer lesions on their breast that I can’t do anything about, which happens (fortunately) not too often, but nonetheless more often than I would like. Actually, one in a career is more often than I would like.

Dr. Srivastava begins:

The consultation is over and I stand to escort her out. Through the open door, I notice the waiting row of patients staring drearily at the television.

“But I am not done yet,” my patient says plaintively. “I still have questions.”

She’s already extended a 30-minute consult and I’m pushed for time. From her purse, she unfurls a long list. With its different colours, arrows and flags it looks like a complicated transit map.

“Should I have my intravenous vitamins on the day of chemo or after it?”

I don’t have a chance to answer before she continues: “Can you move my chemo appointment to fit in a colon cleanse? They are really busy, you know. Booked out weeks in advance.”

The article referenced in Orac's blog post, is truly an excellent piece.

As is Orac's discussion of it.

Sid

[taught_me_patience]

1. big K&R

My sister beat osteosarcoma the conventional way... lots of chemo and complete removal of the joint. Chemo works folks... biopsy showed 99% necrosis of the tumor. She's still alive, seven years later and even has a couple of kids.

[KamaAina]

2. Also, Steve Jobs.

Woo kills.

[SidDithers]

3. +1...nt

Sid