This week I sit in on a lung cancer clinic where I met a wonderful pair of drugs smuggling 70 year olds, who talked all about the fun times they are having despite one of them having terminal lung cancer. Later on in the week, we spend time talking to patients who have come in for chemotherapy; the patient who my partner and I are 'assigned' to talk to is a local celebrity from his art, though the side effects from the chemotherapy are ruining his career.
Through all these clinics I have been sitting in on, I am becoming aware of how important research seems in cancer medicine. There are special research nurses here, whose job it is to run all of the drugs trials that are occurring. A large number of patients seem to be on some trial or another, which can be very confusing, as the doctor who is treating them is also not sure which medication the patient is on, or even if the patient is on any medication at all, or just a placebo. Trials can only be carried out if one option is not known to be better than the other. For example, if a drug is known to treat cancer, then trials will usually be done on top of these 'gold standard' treatments, the intention being that the patient will still get the best treatment even if the trial drug turns out to be rubbish. This is clearly the most ethical way forward, but having the patients on a number of drugs can make it very confusing for the doctors to work out which of the drugs is creating the side effects that may stop the patient from taking their medication. I suppose research into treatments against cancer is a very hot topic, with cancer often in the headlines of popular newspapers, so it is only to be expected that the oncology department is so focussed on research.
Does anyone else remember super-gran? Perhaps she was just on crack...
One of the patients who was on such a clinical trial was a 75 year old lady with incurable lung cancer. In addition to the treatment she would normally receive for this disease, she was also being given a drug being trialled. In this case, as with most clinical cases, the patient was a lot more interesting than the medication she was on. She was quite a loud and jokey person, and had come in with her friend who was equally boisterous. This gives the consultation a very different atmosphere to the one I had been getting used to. Normally they are very quiet, mature consultations, as you would imagine when people dying and the "C-word" is being discussed (cancer). Here, the atmosphere was completely different (with a different C-word being used regularly) and laughs all around. This patient and the friend she had bought along to keep her company at the consultation were outrageous! After the standard questions had been asked by the doctor, and he was writing up in the notes, we started hearing some of her stories. It turns out that for the last month she had been on holiday with her friend in spain "getting pissed and stoned". She told us that she was scared about how easy it would be to get drugs in Spain at her age, so smuggled out a "load of pills and weed". After her amazing month, a lot of which she cannot remember, she had realised how easy it was for her to get drugs in Spain, so smuggled back a selection for "personal use" on her way back. She refused to tell us her trade secrets, how she evaded customs, but did offer to sell us some of her stash, at what she claimed were very good rates.I told her, in a jokey way, that she was being a bad influence on us poor young ones, but she just shrugged it off and winked, poked at me and told me that she was sure that we had done these sort of things before.
Despite the legend of a gran, the consultation wasn't all fun and games. She really wanted to stop all of her chemotherapy and enjoy her last few months of life, because of all the side effects she was getting from it. She was getting things like tingling legs and mouth ulcers, things that other patients who we have seen would love to have over the side effects that they put up with, but each person has their own tolerances as to what they would put up with, and these need to be respected by the doctors. I suppose she had decided that she was happy to die, and just wanted to enjoy her last months doing what she wanted, without strange feelings or pains. This was a difficult decision with the doctor, but she was convinced to wait until the next consultation before stopping everything, and was just taken off of the trial medication in case it was causing these effects. It is likely to be the standard chemotherapy causing these, as these are well documented side effects, but this is a chance to see what happens. She was so much fun, I wish her all the best. She did talk about her children and grand-children who she thinks have no idea about her life style. I doubt this is true, but if it is, perhaps someone out there has this rocking gran without even knowing it!
Steve Jobs avoided surgery for his pancreatic cancer for some time, instead choosing to try out alternative treatments
Later in the week, when we are talking with patients who have come in to receive chemotherapy, we meet a local celebrated artist at the centre. He is very demanding that the drugs don't affect his art, but because of the peripheral neuropathies that keep being induced, the time has come for him to choose between continuing treatment or his art, a very hard choice for him. Without the treatment, he will die from his cancer; while with treatment he will probably still die of the cancer, but a lot more slowly and more comfortably. He has already spent all of his savings on avastin, an anti-cancer drug that isn't funded by the NHS (questions about efficacy) as it is possible it could help him. This is understandable from a medical students perspective, but he also spends his money on a lot of alternative treatments. As well as having mistletoe injections twice weekly, he also has tried many other treatments including homoeopathy and talking with a psychic. These are much harder to understand from the scientific background we are taught in, but doesn't mean that they are not popular. Even the great Steve Jobs tried many alternative treatments for his pancreatic cancer, including acupuncture and a psychic, before deciding to consent to surgery. These were decisions that may have let the cancer spread and eventually killing him. Fortunately this patients seems to have a very sensible approach of using the two in tandem, and I am definitely not one to argue with him. If it brings comfort and the thought that something may be helping him, then it would be unfair to try and take away this from him, even if it is just the power of the placebo. He is currently funding his alternative therapy and travel to the cancer clinic by selling his paintings to the cancer centre, which is kind enough to buy them from him so he can continue his treatment. Everyone wins, as they look fantastic on the walls.