Treats without Tricks, Please

What does it mean to treat a disease? The simplest sense is to restore normal health, to “fix” what is wrong, to make the disease go away and not come back, as if it had never been present at all. Sometimes medicine can do that; applying effective antibiotics against an uncomplicated infection produces eradication, and if the antibiotic has exerted no side effect, I am much the same as I was before, save poorer for the cost of the prescription. I am certainly healthier after treatment than I was while the infection raged. I have been cured. I am better.

What we mean by “better” can vary, though. We are usually satisfied if treatment takes care of the immediate problem even if it leaves some residual, even permanent, change. I go to the emergency department with severe lower abdominal pain, vomiting, and a fever. My appendix has nearly burst, but I have come in time. A skilled surgeon removes my sick appendix, relieving me not only of the discomfort but the threat of serious, even life-threatening, complications. After healing, I am left with a small scar defacing my once-pristine abdomen. I willingly embrace the trade-off, though, sacrificing my vanity for my health. I shouldn’t be wearing Speedos to the beach, anyway. I have again been cured. I am better, even if no longer quite the same.

Perhaps during my brief hospital stay the nurses find that my blood pressure has remained abnormally high even after all the stress of the acute appendicitis has resolved. The condition has not improved when I go to my outpatient health care provider. After investigation, she determines that I have primary hypertension and that I should begin taking medication to lower my blood pressure. I don’t smoke, I maintain an ideal body weight, and I exercise regularly, so I lack a fixable cause that will return my blood pressure to normal when resolved. However, the medication works and I tolerate it well. Treatment lowers my related risks of heart attack, stroke, and kidney damage. I am better, but the hypertension will recur if I stubbornly refuse to take my medicine. I am not cured. The hypertension is not gone, just under control, in a similar way that a caged lion poses no immediate threat to those outside. Again, I am changed, but I prefer this change to leaving dangerous hypertension uncontrolled.

On later follow up, however, testing discloses that the blood pressure medicine, still working well for its intended purpose, has produced an elevation in my triglycerides, a kind of fat. Either I must take a different drug, or I must now adjust my diet and perhaps take another medicine to combat the unwanted side effect of the first drug. My health care provider works diligently to reestablish an equilibrium, and the result is one more return to near-normal, but at a price—now I’m taking two medicines. Still, my health condition is treatable even if not curable.

What has all this to do with cancer? In oncology, we also deal with varying attainable goals. The best of all possible outcomes following a cancer diagnosis is cure, although with uncommon exception we will not know this for several years after treatment, and often must maintain vigilance against a later recurrence. Sometimes we can apply additional treatment to reduce the risk of cancer recurrence and stave off that recurrence for a long time. Sometimes we cannot get rid of the cancer, but available treatment can keep the disease under control for weeks or even years. Sometimes we cannot control the cancer at all, but we can apply various treatments to make its manifestations easier to bear, at least for a time. All of these circumstances are “better.” Some, however, are better than others.

There is always something we can do. Even if the disease itself is past control, we can always treat the person afflicted by it. We can find a path to “better” by easing pain and other discomfort during the dying process. No tricks involved, just good medicine.