Should we try to treat terminal cancer while there is still life?

The patient had late-stage esophageal cancer, anemia due to poor nutrition and the effects of chemotherapy. Seeing the patient's thin, exhausted body, Dr. Le Van Thanh, Department of Abdominal Surgery 1, Central Cancer Hospital, advised the family to temporarily stop the current regimen to improve the patient's condition first, including blood transfusion, fluid infusion, and nutrition.

"If the patient's condition improves, they can consider further chemotherapy or immunotherapy," the doctor encouraged. However, the family refused because they were afraid that "if they don't start chemotherapy right away, the malignant cells will spread quickly and they will die soon." They believed that treatment would only stop when the patient was weak and no longer strong enough.

"It is the patient and his family's choice," said Mr. Thanh. As a treating physician, he analyzed for the family whether chemotherapy until the end of life would be beneficial, making the patient live longer and happier, or in return would be months of tormenting pain and exhaustion.

Similarly, a 45-year-old woman with acute leukemia who had been treated with stem cell therapy thought she had been cured five years ago. However, since March last year, she had to be hospitalized because the malignant cells had returned and had to undergo chemotherapy several times. Currently, the patient is hospitalized for infection, a terrible condition that can take her life at any time, but the patient asked the doctor to continue chemotherapy with the optimism that "the disease will definitely be cured".

Many studies around the world have shown that patients with metastatic cancer are willing to accept all treatments, including toxic ones that only bring minimal benefits. This stems from an optimistic mentality, also known as "while there is life, there is hope", trying their best to be cured. In fact, medicine is increasingly advancing with breakthrough treatments. Medical technology focuses on "defying death" at any cost, thereby instilling in patients, their families and doctors the hope that they can be cured no matter how serious the disease.

However, studies have also shown that chemotherapy makes the lives of terminal cancer patients worse due to side effects such as physical weakness, nausea, loss of appetite, hair loss, etc. For example, a study published in the Journal of the American Medical Association (JAMA) studied more than 300 patients with metastatic malignant tumors and in the final stages of the disease (prognosis of only about 4 months to live). Based on the criteria for assessing the physical and mental health of the patients in the last weeks of their lives, experts concluded that chemotherapy does not help improve the quality of life of patients, and recommended that doctors consider this group.

The Centers for Medicare and Medicaid Services (USA) also determined that chemotherapy in the final weeks of a cancer patient's life is unnecessary and discourages hospitals from doing this.

Currently, Vietnam has no official statistics on the number of people with terminal cancer who wish to receive chemotherapy. However, doctors say that the "while there is life, there is hope" mentality is still pursued by many patients and their families, typically asking for chemotherapy with the hope of "destroying malignant cells, preventing metastasis, and prolonging life".

However, ethical and professional principles require doctors to make decisions based on the patient's health condition. In severe cases, doctors address psychological issues, treat symptoms, and advise on palliative care to improve the patient's quality of life. This care includes two parts: pain relief and mental care.

With proper palliative care, patients can reduce physical pain, relieve negative emotions, and live meaningfully in their final years.

Doctors advise families and loved ones to accompany medical professionals in the fight against the disease. Families should discuss with the patient so that they can make their own choices, not make decisions for the patient.

"Instead of forcing painful treatment, families can choose palliative care, helping patients not have to live with the trauma until death," said Dr. Thanh.