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By Alanna Kennedy

Cancerblog

A retired oncologist continues to help patients grapple with the tough questions

By Alanna Kennedy


One of the toughest issues that cancer patients and their doctors face is when to stop treatment. It’s a complicated question without an easy answer—but it’s exactly the kind of difficult topic that appeals to blogger Herman Kattlove, a retired medical oncologist from Los Angeles.

Kattlove began blogging shortly after retiring in 2006 from his position as a medical editor for the American Cancer Society. “My goal is to help teach patients about cancer and its treatment,” says Kattlove, 71. “When I retired, I wanted to continue my role as an adviser.”

In an entry from June 13, 2008, Kattlove encourages patients and their doctors to have a realistic approach when it comes to the pros and cons of continuing treatment. “It’s been an ongoing concern of mine, ever since I was in practice,” he says. “I would see a lot of oncologists around me continuing therapy when it was not going to help. I think many oncologists tend to be treaters and not talkers—they avoid the hard conversations with patients.”


Calling it Quits. When should chemotherapy stop?
Friday, June 13, 2008

This may be the toughest issue I faced in all my practice. … Telling patients that their chemotherapy regimen was no longer working and that a new chemotherapy regimen would almost certainly not help was the same as telling them that they are going to die. Nothing more can be done to prolong their life. This isn’t easy to do. It is much easier (and more profitable for oncologists) to try something else. …

It isn’t always the oncologist who is responsible for this end-of-life chemotherapy. Sometimes it is patients who want to keep fighting or who don’t want to face their mortality. All too understandable.

So why not?

For one thing, chemotherapy can be very expensive. Sure, insurance usually pays for most of it, but as a nation, we are suffering from inadequate health care coverage, partly because it has become so expensive. Also, in some cases the co-pay for the drugs may be quite high and rob the family of precious resources that they may need to deal with the other expenses of the illness or the future. But more important is my sense that dying is part of life and that to spend those last few days or weeks at doctors’ offices, getting chemotherapy and dealing with its side effects takes away from important issues such as saying goodbye and visiting with loved ones.

… I think everyone with advanced cancer that is incurable should try chemotherapy if they are otherwise well enough. … But once a patient is getting into their third regimen, the chances of success become quite low with a few exceptions such as lymphomas and breast cancer.

At this time, patients and their families should be asking hard questions of their oncologists like what are the chances of a new regimen actually prolonging their life or making them feel better. On the other side of the room, I would hope the oncologist would be honest enough to give a truthful answer. These are tough issues and I hark back to what I learned as a young boy—that honesty is the best policy. It still holds true.

To read more of Dr. Kattlove’s Cancer Blog, please visit: kattlovecancerblog.blogspot.com.

To recommend a blog for CR’s Cancerblog column, send an e-mail to Kennedy@CRmagazine.org.