Cancer Diary: Palliative Chemotherapy

(Carl, returning from chemotherapy, getting out of car and onto chair lift)

 

An inescapable decision--and a potentially life-changing one--can be whether or not to provide chemotherapy at advanced stage 4 of cancer. Chemotherapy given when a cancer is incurable (and side effects are minimal, manageable, or acceptable) is called palliative chemotherapy. 

As with nearly anything medical or existential, there are pros and cons. 

• On the PRO side are the intents (if actually realized)
• shrink the cancer
• reduce the symptoms (e.g., pain)
• improve quality of life
• prolong life
• On the CON side are the peripheral aspects
• uncomfortable and/or disconcerting side effects (the same that accompany any chemotherapy: nausea; neuropathy; in the case of some compounds, hair loss)
• "end of life" chemotherapy can feel like grasping at straws, especially when/if the intents are not all met or met at all (an emotional side effect of depressions, desperation, anger--it depends upon the person)
• difficult home conditions exacerbated by the travails of getting to and completing chemotherapy (time, travel, and movement)
• minimal benefit

Carl had palliative chemotherapy. The hope was to stop his stage 4 Cancer of Unknown Primary in its track even though the oncologist had to make a guess as to what had been the primary in order to determine which chemicals to give him. It did not. As is generally typical of CUP, the cancer is so far progressed that it continues its journey throughout the body, gobbling up cells like an evil and occult Pacman.

We did not benefit from a full assessment of Carl's condition and position because it was during COVID and social workers were not available to visit and assist home conditions. The stress that having to take a day off each week, along with a one-hour drive each way, plus two days at home with a pouch, took an emotional toll, given other responsibilities at home (two disabled children needing care) that stole time away from what could have been a peaceful ending to life that would end anyway. Had we known what the doctors know and had the doctors known what we knew, the decision might have been different. (Had hindsight been available, the decision definitely would have been different.)

That same lack of home visit left doctors unaware of the tremendous pressures and manipulations required just to get to and from the chemotherapy site. Since Carl came to chemotherapy in a wheelchair, it is likely that the assumption was made that he simply transitioned from car to chair to rolling into the house. But...our house has 17 stairs to the main floor. We did procure a chair lift, but it took a lot of work and time for Carl to move to the life, using the car door for support, between the lifts on the landing between the first 9 stairs and the second 8, and then into a wheelchair at the top (which someone had to hold for him). Then, and only then, could he "roll" into the house.

For Carl and his circumstances, especially given CUP, which has a dismal record of survival (actually, basically, except for very, very, very rare cases, it is not survivable), and the exacerbating morbid conditions of obesity and diabetes, the better choice (in hindsight) would have been palliative hospice care.

Every situation differs, the pros and cons are offered here -- and there are likely more -- so that others in the same circumstances might have more information available for making a life-impacting decision than we had. In same cases, palliative chemotherapy might provide some precious additional time (if quality can be had); in others, like ours, it can steal from the precious little time left.

For other Cancer Diary posts, click HERE.

Blog editor's note: As a memorial to Carl, and simply because it is truly needed, MSI Press is now hosting a web page, Carl's Cancer Compendium, as a one-stop starting point for all things cancer, to make it easier for those with cancer to find answers to questions that can otherwise take hours to track down on the Internet and/or from professionals. The CCC is expanded and updated weekly. As part of this effort, each week, on Monday, this blog will carry an informative, cancer-related story -- and be open to guest posts: Cancer Diary. 

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