Dec 7, 2014: The Chemotherapy Conundrum

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 …

22 thoughts on “Dec 7, 2014: The Chemotherapy Conundrum

  1. Robin Temple

    Dearest Jeremy,
    Thank you for sharing your deep wisdom, and your own process with consciously choosing each step, with eyes wide open. I think of the counsel I received when facing these conundrums in my own cancer treatment–the “Regret Reduction Approach:” that we make each choice looking back from our future selves to the present moment and consider how much regret we might feel for the “road not taken” in either scenario. That way, we can be more at peace with the choices we make, no matter how they turn out. You are enfolded in my prayers throughout every day as you find your way through this maze of choices to your inner guidance which lights your path. You are a gift.

    1. Jack VanDervort

      This is Jack V., a friend of your sister Amara here in western PA. I am a chiropractor. When Amara mentioned your present plight in conversation, I was moved (by those invisible things that cause our being,) to want to add my voice to the chorus of well wishers, who would stand a tip toe to lift your soul up above the rudeness in this world that could potentially overwhelm your beautiful expression.
      Rest easy and catch your breath upon the hands of those who hold you up. Ride the surf and the force of Love above this rough spot and into that fuller and deeper expression of who you really are. There is strength there.
      God bless, with peace and Love. –Jack V.

  2. Dianne Rule

    Dearest Jeremy,

    Each time I read your words, I hear you heartfelt care for others, even as you walk through this Cancer Conundrum yourself. You summarized it so well. We wrestled with this during my brother’s fight with brain cancer, and now face it again with another precious brother’s battle with aggressive prostate cancer. I have shared your blog with him.

    Please know that I am continuing to pray for God’s Peace and Strength to sustain you and Kristina. You two dear friends possess the sensitivity to the much bigger picture of who you truly are…Spiritual Beings.

    May Peace, Love, Healing and Joy be Yours!

  3. Amara Geffen

    Dearest brother….thank you for your writing, your sharing, your wisdom. Jed, Satchi and I will all be thinking of you this week…beaming love and healing and hopes for the future together. Much love, your survival ally…amara

  4. Uma Simon

    Once again, an extraordinary post. Thank you. Love, Uma….Prayers for you.

    It was interesting to me that after all my rejection of conventional treatment and doctors in general, I received the most heartfelt response from them for me. Having little funds, I was given great treatment in many cases for free. I attribute this to the grace I had of living here and the extreme generosity of really good doctors whom I felt were healers in many cases. I actually felt depressed from “alternative” practitioners who were eager to tell me of the toxicity of chemo, but never really offered any realistic or true anecdotes of people who were healed with herbs and other therapies. I

  5. peter

    holy brother,
    you have captured the poignent paradox of the whole affair! my heart is with you as you walk the hero’s journey this week. with love, peter

  6. Carla

    You are doing amazing work on so many levels and now helping others, as is your path. I forward these on to many friends out there struggling to navigate these murky waters alone. You have given them courage to say slow down to the doctors and demand more integrated care. It’s the most loving way to care for your self by treating your whole sublime being. I knew you had another book in you! Loving your honesty, courage, and massive heart.

    1. Billy Pearlman

      Dearest Kabir,
      It is so hard to write. What can one say? Yet after reading your words about your cancer experience I feel I must respond. You are in a unique position being an Oncologist, a Teacher, a healer, a conscious and compassionate being, and a cancer patient. Your understanding of the cancer experience has never been more clear, more deep, and more precise. In addition to guiding yourself through this aspect of your life, your words will help countless other to navigate the same path in their lives. You are clearly doing the most important and impactful work of your life, and probably making the most important contribution to the knowledge base of caring for a cancer patient.
      Please know that Gail & I send you all our love and healing thoughts,and hold you in our hearts every day.
      Much love,

  7. Rudrani

    Wow! You are such an excellent writer. The chemo conundrum and the Tower of Babel you describe so succinctly have been experienced by all in cancer club. This blog should be your next published book!
    As always, knowing wholeheartedly that planet earth needs your light & wisdom, I see you conquering this sarcoma dragon! I hold you in source light and radiant health.

  8. Diana Tripp

    Beautiful. Kabir. You most definitely reside in my thoughts and prayers. May you continue to see amazingly positive results from this new part of your journey.

    All my love,

  9. Nazak

    Your courage and honestly is commendable. You are a true master and a beacon of light for so many people who are going through their own journey with Cancer…
    You have the Divine light within and I know you are protected as you go through this mysterious journey.

    Holding you tightly in my heart,

  10. Ram

    Dear Kabir,
    What a challenge. It sounds like deciding which route to take is almost as challenging as the actual therapy. Having gone through a similar experience, I can empathize. I know it is difficult but it sounds like you are making informed decisions. You are in my thoughts with love.

  11. Peggy Wrenn

    Beloved Jeremy,

    Your blog was so exquisite, parsing the many levels and layers, in your amazing wisdom. Your writing is a real medicine…amazing. Precise. Whole. Suffering “beyond the beyond” in my words.

    I honor and celebrate my friend, Jeremy Geffen, a pioneering oncologist, a patient and so many selves, so many levels of consciousness, expressed in that writing. I’m holding for Doxil as an ally in your journey, blessing the mystery.

    I love Peter’s comment “holy brother.” or Carla’s “your whole sublime being.” yes,yes,yes

  12. Omkar Naga Jaya

    Your post made me think of Beethoven, who continued to compose after becoming deaf. You continue to do great work and heal others. May this week be easier and wonderfully effective in your own sacred healing.
    Omkar Naga Jaya

  13. Kashi

    Kabir, you are a warrior ! You wield powerful weapons (material and spiritual) and inspire all of us.
    Much love, Kashi

  14. Jan Adrian

    Thank you for sharing the chemotherapy conundrum. The timing of this blog for me is amazing. I just got the results of a PET/CT scan and am considering chemotherapy. I appreciate your sharing your journey with us. I would also like to know some of the ways you are treating other dimensions of your being. If you are willing to share some of those resources with us, I will appreciate. You are in my prayers, Jeremy. Love, Jan

  15. Rudrani

    Dearest Kabir,
    You are the voice of all cancer patients caught up in the tower of babble quagmire. So articulate and so heartfelt. Continue to be strong. I know you will slay that sarcoma dragon or at the least keep it at bay!

    You are a beacon on the planet and I continue to see you in source light with every cell of your body radiating perfect health and harmony.

  16. Kathryn

    Dear Jeremy,
    Once again I thank you for sharing your very self with us. I am almost sure that you have this information I am about to impart but i am going to send it just in case. On Sunday December 7th 60 Minutes presented piece about a Dr. Patrick Soon-Shiong a Cancer researcher. Seems he might be right on the brink o a major breakthrough. Working with doctors at UCLA and a center in Charlotte NC. Quite technical for me to grasp. Very promising. He has been doing a clinical trial with a 62 yr old gentleman with stage 4 pancreatic cancer diagnosed. 2 years prior given only 4 months to live. Excellent results; he is doing well and is hopeful. Check it out if you haven’t already. Hang in there my friend Love you much. Blessings for you and Kristina

  17. Marc

    Hey Jeremy,

    Beautifully expressed, wonderfully written, and respectfully deep. Most of the time, I am simply awe-struck at how you are navigating your cancer journey. I imagine that being a cancer doctor makes this process somewhat easier on the one hand, yet it can make it more gut wrenching on the other hand. I am so happy that you’re documenting your experience – such a gift. Thank you.

    I love you,



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