Hope and Noncurative Chemotherapies: Which Affects the Other?

Clarissa, a businesswoman whose youthful looks belie her 55 years, sits in front of me. Her husband stands behind her. She has been feeling more tired and reports right quadrant abdominal pain over the past few days. She looks at me anxiously as I study the results of her scans on my computer. I can only conclude that her breast cancer has evolved despite third-line chemotherapy with capecitabine. Liver nodules have increased; a chest x-ray strongly suggests new lung metastases. I tell her, "Mrs. Smith, it appears the last round of chemotherapy hasn't delivered the benefit we expected. Your cancer doesn't seem to have receded." She stares at me, dumbstruck, and then glances at her husband and responds with strength: "Very well, doctor. Let's see what else you have up your sleeve. There has to be something else." "Well, we could go with vinorelbine as fourth-line chemotherapy. But the likelihood of benefit is small. In this situation, each chemotherapy course we try is less promising than the previous course." "It doesn't matter. I'll go for it. I really believe that ‘as long as there's life, there's hope!’ We never know, doctor, do we?" Recently, the topic of hope has been a mainstay of The Art of Oncology section of the Journal of Clinical Oncology.1–3 This interest could be linked to the advances in the science of oncology and the plethora of new treatments now available to patients facing incurable cancer or to a growing awareness that nurturing hope is one of the most important tasks in the oncology clinic. Patients seek from their physicians the safeguarding of hope as well as access to the latest information.3 Therefore, it seems essential to better understand the complexity of what defines hope, its impact on the well-being of individuals, and the role of hope in the delivery of health care services. WHAT IS "HOPE" WHEN DEALING WITH LATE-STAGE CANCER?