This week (on December 9th, 2014), I will receive my third cycle of treatment with the chemotherapy drug Doxil. It’s a powerful drug, and another step on the journey, for sure. As I prepare myself for this experience — physically, mentally, emotionally, and spiritually — I am confronted with many questions that arise around the whole issue of chemotherapy; for myself personally, as for so many thousands of people who are facing this experience every day as part of their own cancer journeys.
There is a lot of controversy out there about chemotherapy. I call it “The Chemotherapy Conundrum.”
In the conventional oncology world, chemotherapy is a mainstay of treatment; one of the “big three;” namely, chemotherapy, radiation, and surgery (along with newer, emerging genetically “targeted” therapies and immunotherapies.) Unfortunately, most mainstream oncologists don’t see behind the horizons of conventional treatment, and — beyond the standard chemotherapy, radiation, and surgery approaches — offer patients very little support for the other, often very troubling dimensions of the cancer experience.
In a parallel manner, in the alternative medicine world, chemotherapy is often considered to be not only highly toxic but even severely damaging to people; something to be avoided, even shunned. There are countless alternative medicine clinics and websites offering astounding personal testimonials about supposed alternative cancer cures — which are, unfortunately, almost all unproven, for a variety of reasons, and are often based on very shaky, if not deeply dubious, rationale. Nonetheless, when faced with a terminal cancer diagnosis, the promise of hope — any hope — can be compelling, even if it is misplaced. Many alternative cancer practitioners deride conventional approaches as aggressively as their alternative approaches are ridiculed, in turn, by conventional practitioners. This struggle is part of what I refer to as the “medical tower of babel.” Many sincere and well-intentioned people who are working hard to care for patients with cancer cannot, or will not, learn each others’ languages and communicate on behalf of the patient. In the struggle between their often radically different perspectives and beliefs, patients and families suffer greatly.
When you are a patient dealing with a cancer for which chemotherapy is recommended — and especially if the cancer is openly regarded as “incurable” with conventional treatment, including chemotherapy, as is mine — this creates a real conundrum. Should you take chemotherapy, or not? How do you decide? Sometimes, the benefits are so clearly established, documented, recognized, and understood that the decision is easy. But quite often, it is a very difficult, even agonizing decision.
In my case, after extensively reviewing the options available to me, I decided to include conventional chemotherapy as part of my overall, multidimensional treatment plan. At least for now — I am continuing with this.
I must admit that my experience with chemotherapy so far has been very challenging. In the spring of this year, I endured three months of a daily, oral, super-high-tech “targeted” therapy called pazopanib (aka Votrient). It was a horrible experience. I was plagued with daily nausea, fatigue, GI distress, weakness, and other side effects. And, in the end, the cancer progressed. It just didn’t work. This was very disheartening, especially because the medical literature suggested that some patients with metastatic soft-tissue sarcomas not only tolerated this drug well, but had significant and even prolonged responses.
Then, over this past summer (July and August), I received three courses (6 infusions total) of treatment with two conventional IV chemo drugs, gemcitabine and taxotere. Those drugs, too, were quite an awful experience. Nonetheless, post-treatment scans at the end of August showed evidence of tumor response, which felt like a real victory. Unfortunately, when I began the next round of treatment, in early September, my body completely rejected the gemcitabine, and I wound up in the hospital with a severe, unexplained adverse reaction. Those days in the hospital, recovering from this reaction, were so awful and depressing that I seriously contemplated stopping all treatment and going on hospice. Somehow, though, I recovered, and possibilities for next steps on the path once again began to open up. As part of this, I was offered “third line” treatment with Doxil. The statistics were again not very encouraging — but not without some potential merit, too. And hopefully, Doxil would involve less toxicity than the previous drugs.
This brought me, once again, face-to-face with the chemotherapy conundrum: should I do it, or not?
After considerable, additional thought, the answer for me was “yes.”
The first two cycles of Doxil (in October and November) were tough, especially complicated by headaches and fatigue. But follow up MRI scans of the spine, just a few weeks ago, again suggested strong evidence that the drug — along with everything else I am doing to try and heal and live through this ordeal — was helping.
And so, I will return for cycle #3 Doxil this week, and will see how it goes.
I have spent so much of my life — personally, and professionally — dealing with cancer in one way or another. My father — and both of my grandmothers — died from cancer. I built and for ten years directed an integrative cancer center, and cared for thousands of patients and their loved ones. I have also walked the cancer path with numerous friends. I have encountered “The Chemotherapy Conundrum” so many times, and in so many ways. I know that cancer touches the lives of virtually everyone, in some way, so I know I am not alone. Here are a few additional thoughts I would like to share about it (for now):
First, there are literally dozens of different chemotherapy drugs, and they work in completely different ways. They also work differently for different people, with different cancers, different motivations, different levels of understanding, and in completely different overall life situations. It makes no sense to lump all chemotherapy drugs together into a single bucket of “good” or bad.” I have seen incredible benefits and results from chemotherapy. At the same time, like so many others, I have also seen people almost destroyed by their toxic effects.
To me, a primary distinguishing factor in whether chemotherapy may be helpful or harmful, or wise or unwise for a particular patient, is the level of consciousness with which it is offered. So much cancer treatment is based on fear. Patients often feel rushed, and are not adequately prepared and supported to deal with what they are facing — let alone guided to make choices from love and understanding. I’ve written about this in my book, The Journey Through Cancer: Healing and Transforming the Whole Person, and am amazed at how true and relevant it has been in my own experience as a patient.
The conventional, materialistic approach to cancer care ignores the essential truth that we are multidimensional beings — with a mind, heart, and spiritual dimension, as well as a physical body — and in my opinion this is absolutely tragic. In doing so, profoundly helpful, powerful, and healing inner resources are overlooked that can truly make an enormous difference in a patients’ experience … and perhaps their outcome as well.
Finally, I have found that both conventional as well as alternative medical practitioners often fail to adequately and appropriately honor the great mystery that ultimately lies behind healing. I think it is as misguided and damaging to reduce a patient to their statistics, their scan and pathology results, and now, ever-increasingly, to their cancer genome sequence … as it is to suggest that their diet, the alkalinity or acidity of their blood and urine pH, or which and how many supplements a day they may take, are what matters the most. All of these factors (and more) should be considered — certainly in a multidimensional approach to care. But in the end, approaching cancer with deep humility, compassion, and an honest appreciation for the fact that we cannot really predict, let alone know with certainty, what will ultimately contribute the most to an individual’s healing, can serve patients, and their loved ones, profoundly.
So, in this spirit, this week I will take my next step with chemotherapy on this mysterious journey. Please keep me in your thoughts and prayers …