Ophthalmology Medical Internship Reflection #3

The Complex World of Cancer Treatment

Cancer. With such variation in its form, cause, and effect, with fundraisers of every kind—from walks for breast cancer to Humans of New York posts—millions of dollars a year are dedicated to researching these diseases  and how to cure them. But when it comes to treatment, what are the obstacles in the way?  From the scientific mystery to the side-effects and dangers, the issues around cancer treatments are just as complex as what they try to cure.

When shadowing Dr. X* this week, I saw almost exclusively cancer patients. Most of them came in with choroid nevuses, freckles that had to be watched in case they became tumorous, or else they came in with the cancer behind them, for post-surgery check-ups. Despite the serious tone of the appointments, there was no lingering pressure in the air. The threat either had not arrived, or it was past. The last patient was different.

Patient John Doe came in at 9AM for tests and didn’t leave until after 1PM. The nevus in his eye had become eye melanoma. Dr. X sat down with him and his daughter, showed him the images, answered their questions, and of course, discussed treatment. She gave two options—the standard treatment, which involved radiation to the general area in a patch sewn directly on the eye, or an experimental new treatment found only in Boston and San Francisco, which targeted radiation on the tumor itself. Up until now, most of the questions came from John Doe’s daughter. His first question: “So this will save my sight?”

The answer was no. The radiation from the standard treatment would likely leave him with only shadows and light (with luck, he may be able to read large print) and while the experimental treatment was likely to leave him with more, he still would lose many of his everyday abilities, such as driving. But if left untreated, he would lose vision in that eye and face the possibility of the cancer spreading to other parts of his body. His indecision was palpable, for whichever way he turned, he wasn’t coming out unharmed.

This incident reminded me of Sadie Winthrop. In eighth grade, Sadie Winthrop and Sam Smith were two Mason students who were diagnosed with leukemia at the same time. “For Sadie and Sam” was emblazoned on every in Mason for two years, eventually, both when into remission. Last spring semester, however, the community learned that Sadie had been diagnosed with cancer once again: this time, it was an inoperable brain tumor (glioblastoma)—caused by the radiation treatment from her leukemia days.

As cancer treatments continue to advance, I wonder whether or not it is possible to create a treatment that won’t hurt the body it tries to heal. After all, a cancer cell is still a cell, and anything that can kill it can kills your healthy cells as well. So, always there is a search for new genes and new techniques. These can lead to targeted therapies, focused on attacking only the affected cells or focusing treatment specifically on the affected area alone. Ideally, this seems to be our best path of action, and such treatments are being created constantly. For example, Dr. Souwedaine, whose efforts on DIPG were recently told by Humans of New York, has created a therapy that works to administer drugs in brain tumors directly to the site itself. Many of these treatments, however, are still experimental and unavailable to the widespread public (either due to cost, FDA approval, or other factors). Such research also enquires innovation, which can be a tricky line in treatment. To be creative, you often have to make various models that won’t work to find the one that does. But for doctors, every failure is a life, and thus they “must invent without being too imaginative” (Humans of New York 2016). Additionally, many of the more common treatments are not as precise, which can kill the cancer, but also negatively affect the patient’s health in other ways.

Cancer treatment can also become a political and ethical minefield. The hot-button topic of universal healthcare envelops cancer care as well and, on the private healthcare side, access to more effective, but more expensive treatments can be vetoed by insurance companies. Certain types of cancer, like pediatric cancer, receive little public funding, and thus is reliant on private donations, with fundraisers often set up by the parents of the affected children themselves. There are high profile cases of individuals with cancer who refuse treatment—sometimes they are celebrated and other times, vilified, but the “right to live/right to die” always remains a controversial topic. In journal club as well, we touched on the lesser-discussed right-to-try. On the state level, some laws are passing to allow terminally-ill patients to use drugs or treatments that are not yet FDA-approved in the hopes of extending or saving their lives. These laws raise questions around morality and ethics, questions which are only set to become more complicated as time goes on. Take a hypothetical example: since cancer arises from malignant mutations in the genes, the only way to rid the world of cancer, as many want to do, is to rid humans of mutations. On one hand, the elimination of cancer would surely be a benefit to the world. On the other hand, stopping mutations, which are often helpful, would stop evolution as well, a subject which would cause even more discussion and controversy.

Even if we’ve never had it, cancer touches everyone’s lives. Society continually works harder on preventative care and education, but once diagnosed, we have a responsibility to give patients the best treatments that we can. Sometimes, our treatments might seem lacking, as they may have to John Doe, who must now decide which treatment to gamble his sight on, or to the Winthrop family, whose child’s cancer treatment lead to another cancer. Sometimes the research is stymied by practicality or funding, and sometime treatment in and of itself can become tangled in political and moral questions. None of this, however, means that we don’t continue to try. Cures are being found month after month, with patients coming home with positive prognosis due to the treatments and research being done. A treatment, even a flawed one, gives hope for the future, and a way to fight back when faced with the impossible. So, we continue in our search for the cure to cancer, all the while being mindful of that finding the cure isn’t the only obstacle facing cancer treatment in the future.

*All names, except that of Dr. Souwedaine, have been changed for privacy purposes

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