When Thomas Menino announced eight months ago he’d been diagnosed with an unknown cancer that doctors said had spread to his liver and lymph nodes, the 71-year-old former mayor of Boston said he was going to fight the disease.
“My attitude really is, we’ll get through it,’’ Menino told The Boston Globe in March. “We got through the [illnesses in 2012], we’ll get through this. I have great doctors and supportive friends.’’
This Thursday, however, Menino announced he was canceling his book tour and stopping his cancer treatment to spend more time with his family and friends. “While I continue to fight this terrible disease, I feel it is time for me to spend more time with my family, grandkids, and friends,’’ he said in a statement, adding, “I am hopeful and optimistic that one day the talented researchers, doctors and medical professionals in this city will find a cure for this awful disease.’’
While many expressed their thoughts and prayers for Menino and his family since the announcement, there was also the uncomfortable sense that this tireless fighter—who hadn’t backed down before, having undergone chemotherapy and surgeries to remove cancerous growths in 2003 and 2012—was giving up too soon.
“He’s doing the opposite of giving up,’’ said Lachlan Forrow, a general internist and the Director of Ethics and Palliative Care Programs at Beth Israel Deaconess Medical Center. “What he’s doing is saying the treatment is affecting my physical energy and maybe emotional energy more than I’d hoped, and I’m going to fight with all the energy I have for the things most important and the people closest to me.’’
Decisions like Menino’s happen every day for cancer patients. According to Choosing Wisely, an initiative in collaboration with American Society of Clinical Oncology to help patients make decisions about their care, treating cancer for the first time carries hope that the initial surgery, chemotherapy, or radiation therapy will destroy the cancer cells. But if the cancer continues to grow, there is a lower likelihood with every treatment that it will be effective.
“With life-threatening diseases like cancer, the medical treatments get identified with fighting, and not doing them gets identified with giving up, when I hope the reality is that what everybody was always fighting for was life, and that’s not just measured in chronological days,’’ Forrow said. “What you’re fighting for is life in the fullest sense.’’
While we don’t know the details of Menino’s treatment, specialists recommend that the side effects of additional treatment after three rounds of chemotherapy, radiation, or surgery, can actually shorten a person’s life or lower the quality of the time they have left. This is when palliative care is often introduced as an option to manage and relieve the stress and pain of a serious illness, with the goal of improving the overall quality of life.
“Where people might say, ‘Oh, he fought the fight and cancer’s going to win now,’ and I believe Menino’s going to prove the opposite,’’ Forrow said. “The cancer might actually succeed in eliminating the few days, weeks, or months, but he’s refusing to let cancer win in fighting the real fight. It’s not touching that.’’
Ideally, the patient makes this decision in collaboration with his or her care team of doctors, specialists, social workers, and family members. And according to Forrow, hopefully everyone has had their eye on the right priorities from the beginning, starting with the human being and what’s most important to them in their life.
Most doctors are so focused on and invested in doing everything they possibly can that they are really late having the conversation that maybe coming to appointments isn’t worth it anymore, said Forrow. While most (approximately 67 percent) of Massachusetts residents say they want to die at home, surrounded by their family and friends, according to the AARP Massachusetts End of Life Survey, only 24 percent of us do.
“At some point, doctors’ visits are no longer going to have a big payoff down the road. You sacrifice one day a week over six months, or however long you might have left, and that’s 26 days away from your family,’’ said Forrow. “We usually just go along with whatever we’re doing, but when we have serious illness, we remember that we’re all mortal, and it’s time to make sure we have our priorities right.’’