Real-Life Decision Making
One of your patients has been diagnosed with lung cancer. This is never
an easy thing to tell a patient. But you know that it is important to relay
this message to them both professionally and empathetically.
There are always lots of questions from the patient and their families.
The main one is treatment. When discussing the various treatments and how
they are performed, as well as the possible results and side-effects,
you have to make sure you inform this patient of all of the possible answers.
"In making a decision regarding a course of treatment, the physician or
surgeon has to make a decision regarding the best possible outcome for the
patient," says thoracic surgeon Dr. Gerald Coursley.
There are two options of treatment for this particular patient. The first
option is medical treatment. It consists of photodynamic therapy.
Photodynamic therapy, or PDT, is a type of cancer treatment. It is based
on the discovery that one-celled organisms, if first treated with certain
photosensitive drugs, will die when exposed to light at a particular frequency.
Photodynamic therapy destroys cancerous cells by using fixed-frequency light.
The other procedure is surgery -- removal of part of the lung, or the whole
lung. Lung masses or tumors are most commonly found on chest X-rays. These
cells may be benign (harmless) or malignant (cancerous). If not removed, malignant
tumors tend to grow and spread to other parts of the body.
You feel that removal has a great chance of actually stopping the spread
of cancer. You have already ensured that there has been no spread of the cancer
outside the chest cavity. Coursley says this is necessary before going ahead
with the surgery.
If the cancer had spread so much that it was not curable, then "the patient
will not benefit and will be subjected to unnecessary surgical procedure."
You have already determined that this cancer is malignant. But it is of
a small enough size that either option has a high success rate.
What do you do?