The aggressive chemo fallacy | Sunrise Rounds

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A good piece by one of my favourite oncology blogs, Sunrise Rounds, on the use of the term ‘aggressive’ with respect to chemo. While he is correct, I think the term is helpful from a colloquial point of view, in helping the patient steel himself for what is to come. For example, knowing that I was going for full myeloblative rather than mild myeloblative treatment left no doubt that I was in for a rough ride. But fundamentally agree, aggressive or not, we want the appropriate treatment that will be most effective for our particular cancer and situation. Quote:

We are in a war, a war on cancer. We talk of battle and attack, magic bullets, proton beam rays, laser surgery and targeted drugs, doctors as combat commanders, patients as foot soldiers, the disease as the enemy, and defeating cancer in a titanic struggle against death. Therefore, it may surprise you to know I am baffled and often take on a momentary blank stare when asked the common question, “Doc, is this aggressive chemotherapy?”

The paradox is that while we want to be fierce in our assault on malignancy, we do not rank chemotherapy by aggressiveness. There is no one to 10 scale to rate chemo from gentle as a daisy to ferocious as tyrannosaurus rex. Saying that a particular chemotherapy is more aggressive than another is like saying that oak is more aggressive than pine. Oak is a hard wood, soft pine easier to work, but when you are building a house each has its place. We do not say to the carpenter, “Whatever you do, use aggressive lumber.” We choose chemo not by aggressiveness, but effectiveness….

Cancer can often be treated without excessive side effects and side effects are not related to benefit. Targeted therapy for the specific disease given in a medically elegant manner can maximize healing while minimizing toxicity. It is not necessary to turn each patient into a piece of dried bacon. This is not to ignore the real toxicity of cancer therapy, which can at times be very hard on both mind and body, but to clarify that side effects are not part of the goal and choosing therapy is not a manner of how hard or how much but how correct.

The aggressive chemo fallacy | Sunrise Rounds.

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