Why Aren’t They Doing More?


Bob Riter
Bob Riter

I sometimes get asked various versions of this question: “My father has advanced cancer, but they don’t seem to be treating him very aggressively. Why aren’t they doing surgery to remove the metastases in his lungs and liver?”

This is always a difficult question because the news is sometimes hard to absorb. When cancer spreads – or metastasizes – from its original location, the focus generally shifts from curing the cancer to controlling the cancer.

There are some exceptions to this. Relatively advanced testicular cancer is sometimes cured by aggressive chemotherapy and surgery. In other cancers, a few small metastatic tumors may be removed by surgery or radiation in the hopes of a cure.

In general, though, once the cancer spreads elsewhere in the body, surgery is not a viable option. Even if the surgeons remove all visible tumors, microscopic cancer cells have taken root in other organs. The analogy of trying to close the barn door after the horses have escaped is unfortunately apt.

The primary treatment for metastatic cancer is chemotherapy because chemo affects cells throughout the body. Many people respond well and their tumors shrink or stabilize. Stopping the progression of the disease is often the goal of chemotherapy for metastatic cancer.

Treatment for metastatic disease generally goes on for as long as the benefits of the treatment (extending one’s life and/or reducing symptoms) outweigh the harm caused by the treatment (generally, the side effects of chemotherapy).

I facilitate a support group for people with advanced cancers. Many have been living with metastatic cancer for several years with a relatively good quality of life, often by receiving chemotherapy on an on-going basis.

When someone asks me why the doctors aren’t doing more to aggressively treating their father’s cancer, I gently ask them what their father wants. I routinely find that patients come to peace with having a life-limiting illness before their loved ones do.

The most aggressive cancer treatment is not always the best cancer treatment. The person with cancer ultimately decides how much treatment is enough. The most fortunate patients make these decisions with the understanding and support of their loved ones. It’s ok to ask those difficult questions. And it’s ok to say, “Dad, I’m here for you if you want to continue treatment and I’m here for you if you want to stop treatment. Just know that I’m here for you.”


Reprinted with Permission of the Ithaca Journal
Original Publication Date: November 3, 2012

Excerpted with permission from When Your Life is Touched By Cancer: Practical Advice and Insights for Patients, Professionals, and Those Who Care by Bob Riter, copyright (c) 2013, Hunter House Inc., Publishers.