HC30: Changes in patients’ experiences

Patients versus medical professionals

While patients experience cancer treatment as a unique life-changing series of events, to medical professionals it constitutes routine work practice.

Joanna Baines

Joanna Baines wrote an article containing 3 stories of 3 generations of breast cancer:

• Grandmother
  • Stayed at home after diagnosis, died at the age of 56
  • For her, cancer was an experience of silence
• Mother
  • Was diagnosed with breast cancer at 35
  • Treatment
    • Radical mastectomy
      • Removal of the entire breast, nipple, lymph nodes, vessels and muscles → severe and mutilating operation
      • Became less and less popular throughout the 1970s
    • Ovarian ablation throughout radiotherapy
    • 5 year follow up of remaining breast and glands
  • Hardly received any information about her condition → saw cancer as an event
• Joanna Baines
  • Diagnosed with breast cancer at 32 years old
  • Received several supplementary tests
    • Abdomen
    • Liver
    • Bones
  • Treatment
    • Removal of the lump and lymph nodes in the armpit
    • Chemotherapy (5 months)
    • Radiotherapy
    • Tamoxifen (5 years)
    • Herceptin
  • She was part of an RCT (randomized control trial)
  • Saw cancer as a part of her life

Timeline

A timeline of emerging cancer therapies has been created:

• 1850-1920: radical surgery
• 1900-1950: radiation
  • Major alternative to surgery before chemotherapy
  • High energy radiation equipment
    • Huge machine surrounding the patient
    • Emerged in the early 20^th century
• 1950-1970: chemotherapy
  • Emerged after the WWII
  • 3 types
    • Nitrogen mustards
      • Discovered during WWII
      • Don’t produce lasting remission
    • Hormones
      • Increased use in the 1940s-1950s
      • Now regarded as palliative
      • Tamoxifen became available in the 1970s-1980s
    • Antimetabolites
      • Sydney Farber diagnosed ALL in a 2-year-old and injected him with aminopterin (an antifolic) → worked very well
  • Didn’t become the cure that everyone had hoped → only prolonged the lives for several months
  • Issues
    • Drug resistance
    • Death due to new complications
    • Survival isn’t worthwhile
  • Many experiments where done in the 1960s
• 1970-1990: combination therapy
  • Dr. Pinkel made a breakthrough by combining high dose chemotherapy and radiation
    • More toxic chemicals
    • Radiotherapy in the brain and chemotherapy in the spinal fluid
    • Double doses in case of no success
    • “Total therapy” → a total hell for patients
  • Even though there was a huge therapeutic optimism, there were several problems
    • Toxicity, response, life impact and trauma, complications, drug resistance, etc.
    • Ethical dilemmas in research of cancer treatment
  • 1978: cisplatin was introduced
    • Highly effective
    • Many toxic effects → kidney failure later on