JAMA this past week (June 3, 1998) carried an article about a study showing cancer patients are excessively optimistic. I don't object to the study. I think it is wonderful that cancer patients are optimistic, as they should be. But the problem is that Associated Press picked it up and implied that optimism for a cancer patient is bad. The AP article put in quotes, "Far too many patients are fighting a battle they cannot win, and not taking advantage of good end-of-life care." The article was shocking! I wonder how many innocent cancer patients will die needlessly because of it. It is difficult enough for a physician to give treatments to an apparently healthy individual and make them ill with less than a 100% chance of success. This publicity will encourage doctors to withhold potentially lifesaving treatments resulting in certain death. What in the world was gained?

And that is only looking at the life and death side and ignoring the quality of life. I know from personal experience that when I was told I was terminal with 90 days to live and nothing could be done, my quality of life sank to an all time low. It became nonexistent. When I was told there were treatments that could help, I was elated. Even when I was being made deathly ill by the chemicals, the quality of my life was far better fighting to live than waiting to die. I am an individual who had non-small cell lung cancer 20 years ago and metastatic colon cancer 10 years ago, the two types of cancer this study picked and stated should not be treated. Thank God I didn't know about this study, or at least my doctors didn't.

Eighteen years ago we started a second opinion center here in Kansas City. The greatest thing that center has done in my opinion is not the lives it has saved, even though initially we believed that one out of four patients coming before the panel had their life saved by these wonderful physicians offering possibly successful treatments. The greatest benefit is that no longer are cancer patients in Kansas City told they are terminal upon initial diagnosis. They may be told this is an extremely bad type of cancer, but let's make some phone calls and see if someone can't do something about it. That's a lot different than saying, "Go home and die." We now have over 100 institutions offering second opinions around the United States, including New York City.

Suppose you were able to access a machine and read the local newspaper printed six months from today. On the front page you see your picture and read that you were the victim of a drive-by shooting. You were killed the previous night! How would this help you and your family? What would this do to your quality of life this afternoon? Tomorrow? Do you believe that if you had the power to look back the day after that shooting you would have believed your life was better for having known it would happen? When a doctor tells a patient they will die in a lengthy period of time, it is like allowing them to read a paper that date in the future.

Dr. Herbert Benson, a specialist in behavioral medicine at Harvard Medical School, states, "Belief is the hidden ingredient in Western medicine . . . A new drug given by a doctor who believes in it enthusiastically is far more potent than the same drug given by a skeptical doctor. . . . Clinical studies have shown that a patient's belief in a medicine can make it far more effective." Once your doctor tells you that you are going to die in six months, how effective are the treatments going to be when you trust and believe in your doctor? Patients tend to fulfill their physician's prognosis. Placebos have an undisputable proven record of success. Does this study want to condemn all those people to death?

A cancer patient appeared very depressed at a meeting. Upon questioning, it was learned that he had received the state-of-the-art treatment for his disease without success and had been told six months before this meeting he was terminal and nothing else could be done. That was the last time he had seen his doctor. He is slowly wasting away. But it is not that he is just wasting away. Any conceivable quality of life he and his family had ceased on that day six months before. There were many other options available, none of which were as good as what had been taken. The physician, in order to "spare" him suffering, made the unilateral decision and taken him off all treatment. Had the doctor talked to this man and explained the situation instead of making the false statement that nothing else could be done, there is no doubt that treatments would have been tried. Whether they would have been successful or not is an unknown, but the fact that the quality of life would have been far improved is undisputable.

There is no such thing as false hope for a cancer patient. Hope is as unique with each individual as a finger print. For some it is the hope to make a complete recovery. But it might also be the hope to die peacefully; the hope to live until a specific event happens; the hope to live with the disease; the hope to have their doctor with them when needed; the hope to enjoy today. Just as each case of cancer is unique, each person is different. Each individual has the right to be told all their options and then decide for themselves.