In one of my favorite theses on the theme of “The Theory of Cancer,” a basic unit of knowledge of cancer is treated as the size of a tumor. I sat with a group of colleagues for many hours staring at 3D maps of human tumors, and come to the conclusion that everyone with a tumor looks the same. What is interesting is the relationship between a tumor’s size and its chance of survival.
This question has arisen again in recent weeks with the news that at the Mayo Clinic, a test that measures one, tiny bit of blood may reveal in just 10 minutes who in a family will die from cancer. Most the time, the one person whose cancer is diagnosed is the most likely person to die. The chances of a dying child at the hospital, or a son or daughter struggling in a hospice, are thought to be about equal. Researchers at an Israeli hospital recently showed that even relative differences in the size of tumors were not always independent predictors of survival.
These studies may change how we treat cancer. We may need to consider this question not only about the number of patients, but also about the effects of treatment on the relatives. For example, in the last decade, a large follow-up study of people with cancer who received more than $1 million in compensation for pain and suffering showed that the awards far outstripped the quality of care provided to the patients. Instead of helping patients, the system seemed designed to enrich the financial consultants advising the medical professionals. Compensation payments are now restricted in most states to $250,000, but it is still possible to generate millions of dollars in pay for talent that did little or nothing to improve the outcome of the patient.
Ethics policies should have provisions that facilitate a faster and less expensive way to diagnose and prevent families from suffering the inevitable lack of comfort and care their loved ones may need. In some countries, one size does not fit all, because even a small tumor can endanger the life of a small child. A great deal of research is underway to find the largest naturally occurring tumor-specific enzymes, so that more than one test can be used to assess different treatments and be used early in a diagnosis.
The bottom line is that families must not be denied the chance to visit their children in the hospital until the size of the tumor has been significantly reduced. This is not a sacred process, but an unavoidable one. In-depth palliative care provided by caregivers committed to this goal is as much a medical necessity as chemotherapy or surgery.
Dr. Emily Binz, Professor of Clinical Cancer Care, Annenberg School of Journalism