Bucks Montgomery Physician Winter 2021 - 8

FEATURE

A Conversation
I
by Charles Dunton, MD, Gynecologic Oncologist

t was my last week after 30 years of caring for women
with gynecologic cancer. I spent the last month
with a series of farewell visits. Saying goodbye to
patients who had survived, some for sometimes over
25 years. It was a good month. There were no new
patients and limited surgery. My stress level was much
decreased. I smiled more. There were many hugs and
some tears from the patients. It was a good month.

The call came on Tuesday of my last week. A long-time
patient was enrolled in a clinical trial at another institution.
Murray, her husband, called to say Arlene had been taken
off the trial. He told the doctor that Arlene was having
pain and was not eating well. They attributed this to the
trial drug. Murray asked for advice. They felt trapped
between care with the physician who ran the trial and
myself who was their physician for the past four years.
I suggested being evaluated in the Emergency
Department at my hospital. Murray and Arlene
declined but wanted to return to my care and made
an appointment for the next day. With retirement
coming that Friday, I saw them the next morning. It was
clear that Arlene's symptoms were from progression
of cancer not side effects of the trial drug.
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BUCKS/MONTGOMERY PHYSICIAN

winter 2021

I treated many long-term survivors after primary
treatment but few who have had recurrences have longterm survival. Most patients eventually recognize that
treatment will prolong survival but not offer cure. Some
patients despite many discussions have difficulty getting
to that place. Each of these discussions are what we do
as cancer doctors, but they are taxing for the clinician. It
takes a bit out of the oncologist to have such discussions
with patients and family. However, it is important to
be honest and realistic. Occasionally, patients feel you
are being a defeatist. Some go to places that promise to
" go all out to cure the cancer. " I always suggest going
for other opinions but resist patients going to places
that do not have clinical trials or outcome data.
I remember some of these women that I have treated
for recurrence who have had long-term remission, and
most likely cure. I remember 15 years ago an energetic
woman coming to see me with an ovarian mass. I told her
I was suspicious that it was malignant. Cathy explained
that in 2 months she need to climb Mt. Kilimanjaro
and that the trip was set. I offered a minimally invasive
procedure, laparoscopy, for diagnosis. Unfortunately,
Cathy had an advanced ovarian cancer, and a full incision
was made, and all visible tumor was removed. The climb

Bucks Montgomery Physician Winter 2021

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