Merry Christmas and Happy New Year, folks! Phew, the last 4 months have been...well... crazy. We've moved across the country, new jobs, planned a PhD (ish), moved house 3 times, bought a house, planned a wedding.... I can't necessarily recommend doing all of these things simultaneously, but equally doing so much 'adulting' in a short space of time feels like something of an achievement!The cherry on this life cake was that I drew the short rota straw and was on call on Christmas Day - maintaining my 100% clinical Christmas working record!! However, I really can't complain - for one thing, as ever, festive cheer was in great supply and I even met Santa :). And secondly, I was able to 'leave the building' and do the remainder of my 24 hours on call from home. That means phone calls at 3am, but it also meant Christmas dinner courtesy of Mr KP!
A lot of being 'on call' for oncology involves being called by other doctors from essentially any clinical department for advice - A+E, GPs, any medical or surgical specialty, intensive care, etc etc. We are often asked to give a view about prognosis and expected outcomes to help them guide their decision making. Prognosis is really hard to gauge, particularly at the end of the phone, sometimes in the middle of the night. Clearly at my stage if it's unclear I'll seek higher wisdom. But my main take home in the year I've been an oncology registrar is this:
- Metastatic cancer does not mean someone is at the end of life. In some cases, they are still curable.
- Palliative treatment does not mean that someone is at the end of life.
- Palliative treatments (yes, plural, for many cancers) can significantly extend life, and quality of life.
- Patients with metastatic cancer on or considering palliative treatment can, in some cases, live for many years and may even die with, rather of, cancer.
The wider world should be encouraged that oncologists are consulted on these sorts of matters, but I can't help but feel we should be doing more to spread the gospel that all that metastasises is not lost. Of COURSE one can never give a blanket, catch-all statement about all patients with cancer - cancer is not one disease. It's lots of different diseases really, with different biology, different molecular profiles and different treatment options. Plus patients may have other medical problems that must be taken into account.
But (for example, and broadly) - metastatic testicular cancer is often still curable. Patients with metastatic prostate cancer have a prognosis of years at diagnosis, as do many other cancer types. Yes, some cancers have a less positive outlook, and it's important we are up front about that too. Also we can't predict how everyone's individual cancer will behave - sometimes they progress faster or slower than anyone can predict. The point is that it varies HUGELY. I sometimes wonder whether we need to change our language as oncologists. Heart failure is a chronic disease which is generally irreversible and can be life-limiting but can be medically treated and extend life - in what way is metastatic cancer different?
So consider this blog post the start of my efforts to get the word out there. My professional New Years Resolution is to talk more about prognosis and manage expectations for patients and medical types alike where cancer is concerned. I am determined to be a pragmatic advocate for my patients.
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| Adventures of 2018 offering inspiration to those of 2019! |
