The patient was a young looking 74-year-old woman, accompanied by her husband. She was not exactly sure why she was seeing me and nodded as I explained that I see all women with anal or rectal cancer who are being treated with radiation therapy. I explained that we recommend that these patients use vaginal dilators to improve elasticity after radiation in the pelvic region, and my meeting with her was an opportunity for me to show her the dilators, educate her about the reasons for their use, and answer any questions she may have.
“Oh, no thanks, my dear,” she began, “I’ve no need for those. We’re not sexually active, and I’ve had a hysterectomy and my family physician says I don’t need a Pap anymore.”
With that, I started to get up from my chair with my hand extended to shake hers and end our meeting.
“Can I ask you something?” she said, still sitting in the chair and not going anywhere just yet.
I nodded my assent.
“Are you a chemo person or a radiation person?”
I paused—this was a question that sounded like there was something else going on. I responded that I was neither a chemo nor a radiation person but that if she had any questions, I could probably direct her to someone who could answer her questions.
“How will I know if the treatment is working?”
She went on to explain that she was almost finished with six weeks of radiation therapy on top of the chemotherapy that she had before that. Her treating team was now talking about more chemotherapy, and she wasn’t sure she wanted to go through that again if her cancer was not responding.
“Have you asked your oncologist about that?” I asked.
“Oh, yes,” she said. “And my oncologist told me to ask again after five years when she would know if the treatment had worked.”
It is rare that I am lost for words, but this was one of those occasions. I sat for a few moments and thought about how I could help her. I explained that we used to think that if a person was cancer-free at five years then she was probably cured, but that our current thinking is a little different. I did not want to confuse or distress her with statistics and probabilities about Kaplan Meier curves of survival and instead decided to ask another question.
“Do you know if you have a scan scheduled in the next few weeks?”
“Oh, yes, I’m having a scan towards the end of the month. Do you know what that’s for? I’ve had so many scans and tests that often I can’t keep them straight.”
At least now I had something to work with so I told her that the scan would tell her treating team if the cancer had responded to the grueling few months of treatment that she had been through. Just that one sentence resulted in a smile.
“Thank you SO much, my dear. What a relief! I have been wondering all this time how they would know if the treatment was working, and you answered my question, just like that!”
At this, she stood up, shook my hand, and opened the door of my office.
“What a great help you’ve been! I’m so glad I came to see you!”
And she was gone.
I will never know what her oncologist heard when this patient asked the same question. Perhaps this patient had framed her question in a way that was open to misinterpretation. Perhaps the oncologist was thinking about something else or was tired after a night on call. Or, perhaps she wasn’t listening at all. In any event, a flippant response—ask me in five years—was not helpful to the patient at that moment.
The patient was trying to decide if additional treatment was going to be worth the pain and side effects, and she had a simple question that deserved a serious and simple answer. Had the treatments worked? Had what she had gone through—chemotherapy and radiation therapy that makes most patients feel vulnerable and, at times, violated, done any good? And her treating physician had not answered her. Instead, she found the answer with someone who was not a chemo or radiation person and whose intervention she didn’t need. But, at that moment in time, I listened and answered, and I helped her. I am grateful that she attended that appointment. I’m pretty sure that she is too.