I am a retired 82-year-old Hematologist/Oncologist who reads The ASCO Post regularly. I am writing to share some brief thoughts with the authors of two articles in the February 10, 2020 issue.
First, I would address the article, A Hopeful Look Ahead in Oncology, written by Dan L. Longo, MD, MACP.
I was graduated from Loma Linda University School of Medicine in 1963, 57 years ago. My postgraduate training was all at the University of Alabama (UAB) Medical Center in Birmingham, between 1963 and 1971. This included my residency in Internal Medicine, 1 year as Chief Resident in Internal Medicine, and a fellowship in Hematology and Nutrition. I also spent 2 years in the United States Air force between 1965 and 1967. At both UAB and subsequently at Loma Linda University I served as a junior faculty member in Hematology-Oncology.
I passed the Internal Medicine Board in 1970, was one of about 350 individuals who passed the first Hematology subspecialty board in 1972 and the first Medical Oncology subspecialty board in 1973.
I agree that many patients in the 1960s and 1970s were made very ill by our treatments, and unfortunately the percentages of those who had a significant benefit were still very low. In 1970 the median survival of all patients diagnosed with an invasive malignancy was only about 35 %. When I retired in 2012 the median survival was about double at 70%.
However, I was glad to serve as a Hematologist-Oncologist during those years for four reasons. First, the median survival of patients with cancer had increased significantly. Second, we were able to improve the quality and length of life of many individuals who were not cured. Third, many patients and their families expressed sincere appreciation for what we did for them. Fourth, with a spiritual orientation in my life, I realized that no group of patients or their families were more in need of a spiritual ministry or more responsive to it than our hematology-oncology patients.
Major improvement in treatment has obviously continued since my retirement in January 2012.
On Denial and Empathy
Second, I also appreciated the article, Denial’s Many Faces, by Adrienne R. Boissy, MD, MA, and Mikkael A. Sekeres, MD, MS (also published previously in the Journal of Clinical Oncology).
The first of my two most challenging cases of denial was the family of a 35-year-old man who died of lymphoma. The patient’s family would not let us move his body out of the hospital room because “he was going to be raised back to life very soon.” Fortunately, they accepted the chaplain’s offer to move him to the hospital chapel initially and then later agreed to move him to the funeral home.
The second case was that of a 55-year-old lady who died of metastatic breast cancer. The patient and her mother could not accept that “God would let her die” and the patient did not want a “do not resuscitate” order prior to her death. Her husband was at her bedside when she died and he agreed that we should not try to resuscitate her.
Finally, “being on the other end of the stethoscope” has been challenging. As a lifelong non-smoker I was diagnosed with asymptomatic pathologic stage IIIA adenocarcinoma of the right lower lobe of my lung in October 2018. It was probably related to radon exposure over a 35-year period of time. My treatment has included thoracoscopic right lower lobectomy, followed by four cycles of adjuvant chemotherapy complicated by a port infection and clinical sepsis. In August 2019 I was found to have a solitary metastasis to the right upper lobe that was treated with stereotactic ablative radiation therapy. I continue to be asymptomatic with my next CT scan scheduled in the middle of April. I’m not in denial but I do weigh the benefits and possible complications with more knowledge of both than a non-physician patient!
—Ronald E. Turk, MD
Dr. Turk has been a member of ASCO since 1972.
Disclaimer: Letters to the Editor represent the views of the author and may not necessarily reflect the views of ASCO or The ASCO Post.