After Chinese New Year, the number of very ill patients who come to see me invariably increases – a trend that I’ve observed over the years. I’m not sure why it’s so but I presume it’s partly because some patients delay seeking medical care just before the auspicious day. The other reason is perhaps over reunion dinners and family visits, friends and family share their stories, and offer advice and recommendations on where to seek medical attention.
This year was no different. I saw Margaret a few days ago – she weighed only 28kg when she was wheeled into my consultation room by her sisters. ‘We have been trying to convince her to seek medical treatment for so long,’ lamented one sister.
Margaret was diagnosed with stage 2 nasopharyngeal cancer, often called nose cancer, 18 months ago, when she had bloody nasal discharge and went to see a doctor. She was advised to go for treatment but flatly refused. Her experience with cancer had not been good. Her brother died at the age of 28 from cancer of the nasopharynx – the area at the upper part of the throat behind the nose – eight months after treatment. Her sister died at the age of 36 from cancer of the cervix, just six months after treatment.
It was no wonder that she turned to alternative treatment when she was told that she had nose cancer. It did not matter to her that, unlike her siblings, her cancer was diagnosed at an early stage with a very high (estimated 80 per cent) chance of cure. ‘She started herself on a diet of only organic food and lost a lot of weight. She did coffee enemas and tried everything, only to get worse and worse,’ said her sister. Margaret was a pitiful sight.
There was a large tumour on the left side of her neck, restricting her neck movement. Wheelchair-bound, she could not even get onto the examination couch for a proper examination.
She could barely talk, whispering monosyllabic answers and looking pleadingly at her siblings for help to answer my questions. Despite her advanced cancer, I believed that there was a reasonable chance that treatment could kill the cancer cells, shrink the tumour, relieve her of her symptoms and restore some quality to her life. I showed her before and after photographs of some of my patients with nasopharyngeal cancer whom I had cared for over the years.
Nasopharyngeal cancer is a disease that is very sensitive to chemotherapy. More than 70 per cent of patients with this form of cancer, no matter how advanced, will respond to treatment. But I also said treatment would not be without its risks. In Margaret’s debilitated state, many things could go wrong.
She could acquire an infection and perhaps even die from treatment. Without treatment, it was doubtful if she had more than a few months to live. By the end of the consultation, she agreed to undergo further tests to determine the extent of the cancer spread and evaluate her fitness for treatment. She appeared keen to consider chemotherapy to arrest the progression of her disease.
One big issue was where she would stay during treatment. She was residing in a hospice as no one was able to look after her at home. Hospitalisation during the entire period of treatment would be too expensive for her. I roped in the help of my colleague, Dr Kok Jaan Yang, a consultant in palliative care.
He agreed to assist me in providing ‘comfort care’ to Margaret, while she undergoes treatment for her nasopharyngeal cancer. He tried to convince the hospice to allow her to stay on while she was undergoing treatment for the cancer. They said no, as the primary objective of hospice care is treatment aimed at relief of symptoms, not treatment of the disease and prolongation of life.
Patients receiving ‘active treatment’ for their cancer could not remain in the hospice. I understand their position but perhaps the administrators can be given greater flexibility in deciding who they can admit. The differentiation should not only be about whether the treatment is active or not, or a person’s potential length of life, because who can tell anyway? Rather, it should also be about degrees of abilities – to what extent a patient can care for himself while undergoing treatment.
The larger lesson for me in all this is that Margaret is in her present predicament because of her misplaced faith in alternative medicine. I am not sure if she agrees with me.
My hope is for her to get well and tell others of her journey in her own words.
This article first appeared in “Mind Your Body”, a Straits Times Supplement.
Tags: nasopharyngeal cancer