Small Cell Lung Cancer Concerns
Recently my 58-year-old father was diagnosed with small cell lung cancer. He has undergone chemotherapy and radiation therapy. He smoked 40 of his 58 years. My father is unaware of the lifetime effects this cancer has, and that he has no chance of cure. The doctor has chosen not to tell him this information unless he asks. This is in an effort to keep him positive and fighting. Our family is aware and understands what this disease entails. I wanted to know if this is common practice?
Barbara Campling, MD, Medical Oncologist, responds:
I am sorry to hear about your father. It is peculiar that his oncologist has put him through a course of chemotherapy and radiation therapy without having a frank discussion about the prognosis and goals of treatment. This certainly is not common practice among cancer physicians. Do you think it is possible that you father's physician may be telling him more than your father lets on to his family? Maybe your father is trying to keep the family in a positive frame of mind.
The fact that he was treated initially with chemotherapy and radiotherapy suggests to me that he may have "limited-stage" small cell lung cancer (SCLC), in which the tumor has not spread outside of the chest. If this is the case, his outlook may not be entirely bleak. A small, but significant, proportion of patients with limited-stage SCLC may actually be cured of their cancer with an aggressive combination of chemotherapy and radiotherapy, typically administered at the same time. The patients who are most likely to be cured are those who have a rapid complete response to treatment. If your father falls into this category, he may have reason to feel upbeat, even in the face of this very serious diagnosis.
You also implied that your father has stopped smoking. Patients with SCLC who stop smoking prior to diagnosis actually have better cancer outcomes and responses to therapy than patients who continue to smoke during the course of their treatment. On the other hand, if your father's cancer recurs, and you and your family still feel that his physician is not acknowledging the seriousness of the problem, it would be worth consulting with another physician.