“You Have Nothing to Lose.”

Lee Newcomer recently wrote a most provocative article in the Journal of Clinical Oncology (May 10, 2015). A friend of his, “John,” was most perplexed by the treatment recommendations for his wife, “Jan.” The recommendation was for chemotherapy after surgery as well as radiation to follow. Both of them did Internet research. They both agreed that the radiation should be undertaken; however, they had questions as to whether or not the chemotherapy was required.

They received a second opinion from a major cancer center. The consulting physician explained to them that chemotherapy would provide some benefit. However, the doctor also told them “you have nothing to lose.”

I disagree. There was definitely something to lose. Jan’s life “would be turned upside down for 6 months. She and John would have to
rearrange their work schedules and find childcare for her treatment days.”

COMPLICATIONS OF CHEMOTHERAPY CAN OCCUR

Jan’s risk of death is small, but not nonexistent (2 per 1000 patients). But the chance of having an emergency room visit is 75% and 13% chance of hospitalization.

WOULD I HAVE RECOMMENDED CHEMOTHERAPY AS WELL AS RADIATION TO JAN?

Yes, I would. But I would also make sure that Jan and John were aware of all of the risks and all of the benefits of chemotherapy and radiation. Physicians must be aware that all recommendations of treatment need to be weighed on a risk/benefit basis. The only way Jan and John could make a rational decision regarding cancer therapy would be by knowing all of the facts.