Palliative vs. Curative Intent

[Mtngrl]

It's not exactly the sticks. It's Denver, Colorado. But our population density is much less. And I'm lucky. I live about 15 minutes away from the hospital.

When I raised the idea of local treatment to the lungs in Boston, the NP I was talking to said, "They don't do that with Stage IV." I knew then that was flat-out wrong. I had been reading about studies of the efficacy of local treatment at places like M.D. Anderson. So it's not just because I'm now more geographically isolated.

Palliation isn't just about pain relief. It's about trying to optimize available resources. But not everyone sees it that way.

I don't know if it came from the medical onc, or it's just standard practice, but when I first met with the radiation onc they were thinking they'd do a short course of radiation with a low dose just to make me more comfortable for a few months. But after talking to me awhile the resident said, "You look really good. You don't look like you have cancer. I have to clear it with my attending, but I think we should try to eradicate the tumor." He went on to say there was a bit more risk of side effects, but he thought I'm a good candidate. His boss agreed.

Chemo was making me pretty darn sick when I quit in December. I felt awful for at least 10 out of every 21 days. After the March scan my medical onc wanted to put me on Gemzar, with a three week on, one week off dosing schedule. I said we should save that for later, and opted for just Perjeta and Herceptin for awhile. I wanted to get my strength back and let my immune system rebound.

I didn't think about local treatment in my lungs at that time because it wasn't raised as a possibility. I'm glad I was eventually sent over there, and I'm optimistic about the outcome.

Here's the point: What could be more "palliative" than eradicating the cancer and avoiding consequences like pneumonia by using a safe, effective, standard treatment modality? There's overlap between "curative" care and "palliative" care. Taking reasonable steps to put me into NED territory would be pretty frickin' palliative, in my view. And I'm still hoping for that.

Amy

[Kim in CA]

Hi Amy,
Glad to hear you are finally getting some localized treatment for your lung mets. Unfortunately many oncs are behind when it comes to treating stage IV patients with oligometastatic disease.

you and I definitely fit in that category, and it is up to us to push for treatment, as it only makes sense.

https://moffitt.org/media/4879/21.pdf

When I had my last recurrence to the peri rectal area of my abdomen, I immediately asked about getting SBRT to the area. My onc presented my case to the radiology docs, and it was their opinion that my tumor was too close to the bowel to receive radiation, because of possible complications. Fortunately the Kadcyla has taken care of the tumor and nearby lymph nodes that were lit up.

My next scan is in Oct. and you can bet if any new mets are present, I will be touting the "whack a mole" strategy that our dear Brenda used to call it!

Kim