Treating Cancer: Make Medical Decisions Calmly and Rationally

When a patient is desperate, they will turn to any doctor—that is human nature. Especially after being diagnosed with cancer, people become even more panicked and tend to make rushed medical decisions. Under current medical conditions, cancer patients face many choices: surgery, radiotherapy, chemotherapy, endocrine therapy, targeted drugs, immunotherapy, and Chinese medicine. Each treatment has its pros and cons; how to choose is truly a difficult problem for ordinary people.

It is undeniable that some medical institutions and healthcare workers now, for their own benefit, disregard patients' interests and induce patients and their families to make choices that benefit the providers. Doctors and patients/families are asymmetrical in their control of medical and technical information, so when a healthcare worker induces patients and families as an authority, patients and families are easily persuaded.

I often encounter patients and families asking me how to choose among various treatment options; most have already visited multiple medical institutions. The opinions given by doctors at each institution differ, some even contradicting each other, leaving patients and families at a loss—not knowing whether to choose surgery, radiotherapy, chemotherapy, or other treatments. I use my knowledge to help them analyze the pros and cons of each treatment and then help them clarify their thinking.

Actually, patients and families might as well buy a small medical handbook like the Oncologist's Handbook (preferably one published by authoritative publishers such as People's Medical Publishing House or Peking Union Medical College Press, compiled under the leadership of national institutions) and browse through it. Although they cannot gain a thorough understanding of cancer treatment in a short time, reading such handbooks can be very rewarding. From examination, diagnosis, to treatment, cancer takes a long time; while waiting for treatment, frequently flipping through such a handbook reduces blindness when making choices and helps identify the bad intentions of healthcare workers who deliberately mislead patients for their own benefit.

In most cases, the opinions given by reputable doctors are fair and considerate of the patient. But patients and families still, because of their own anxiety, make hasty decisions during the consultation process.

For example, some patients have tumors with surgical indications; according to relevant guidelines, surgery should be the first choice. But the hospital cannot immediately arrange surgery and instead has the patient wait in line—generally speaking, wait times at hospitals in mainland China are not long, mostly just one to two weeks. But patients and families are impatient and think about doing some other treatment during those one or two weeks.

I generally tell patients and families to calm down and not rush into other treatments before surgery, because cancer is a chronic disease that does not progress that quickly; waiting one or two weeks will not cause the tumor to spread beyond control. But if during the two-week wait for surgery, the patient experiences severe side effects from other treatments—such as cardiac toxicity or liver-kidney toxicity—the surgery may have to be postponed. That would be a loss outweighing the gain for the patient.

This situation is very common; on average I encounter 2–5 similar consultations per week. Just this week, a relative of mine with thyroid cancer was agonizing over this issue; she was anxious about waiting for surgery and wanted to first take Chinese medicine or use other methods to shrink the tumor a bit, and I dissuaded her. Today a family member of a brain tumor patient was also anxious over this issue; PET-CT showed that besides the brain tumor, there were no tumors elsewhere, and the brain tumor also had surgical indications. Surgery should of course be the first choice. But the surgeon could only schedule the surgery two weeks later. At this point, radiology doctors at other medical institutions told the family that radiotherapy was also an option. The family wanted to do radiotherapy or take oral Chinese medicine before surgery to shrink the tumor, and I also dissuaded them. Because patients and families do not understand the side effects of oral medication and radiotherapy, they have not considered the risks these treatments may pose for surgery.

There are also patients and families who, eager for treatment, after choosing one treatment, before even evaluating its efficacy—or even after confirming the current treatment is effective—immediately want to add another treatment. Their eagerness is understandable, but their approach is inadvisable.

In cancer treatment, after choosing a regimen, one must patiently wait and scientifically evaluate efficacy. Before the evaluation results are in, one should not start a new treatment. Because most cancer treatments have significant side effects, if multiple treatments are stacked simultaneously, once effective, it is hard to tell which regimen is working. And once these treatments produce compounded side effects, the patient will suffer terribly during treatment, quality of life will drop sharply, and survival will be shortened—this is typical overtreatment.

Over these past few months, a melanoma patient's family has been consulting me regularly, and recently even had me participate in their family member's treatment. They have successively used chemotherapy, interferon therapy, PD-1, Chinese medicine, and other methods. On the TCM side, they first saw an elderly TCM physician in Yunnan, and then came to me. Previously the patient's tumor was progressing; after I recently joined the treatment, the patient retained interferon and oral Chinese medicine, and the tumor shrank by about one quarter. But the patient's family then learned about some targeted drugs through various channels and wanted to add them simultaneously.

In fact, after this patient used immunotherapy, an autoimmune reaction occurred, with severe pain to an unbearable degree. On my recommendation, taking Maxing Yigan Decoction stopped the pain, and then some tumor-resolving Chinese medicine was taken, and the tumor also shrank. In this situation, the family's eagerness to add targeted therapy for the patient is an irrational decision. I can only persuade them not to be so impatient. Cancer is not easy to treat, and achieving efficacy is very hard. When efficacy is confirmed, one should stick to the original regimen; repeatedly changing regimens only adds risk, accelerates the patient's death, and increases suffering.

Cancer treatment is not as simple as one plus one being greater than one; more often, it is more like one plus one producing endless side effects, and the original efficacy cannot even be maintained. When treatment is effective, be steady on the treatment path; it is better to go slowly than to haphazardly add regimens and end up defeating your own purpose.

For each patient, the optimal treatment regimen does not come from literature but is groped out in practice. Once treatment is effective, do not act rashly or change course. If doctors and patients want to pursue better efficacy, the safest approach is, on the basis of the existing regimen, to cautiously move forward in small steps, rather than blindly piling on treatments.