Wednesday, September 7, 2016

Oncology Attachment

Hello! I am finally back in Cambridge to start my Year 5! Ok, technically, I have been back since mid-August. A lot has happened, but nothing happened that moved me enough to make me write a blog. Not today! 

Today's my third day in my oncology attachment. I have good friends who's super into oncology and I've talked to them many times on why they wanted to do such a 'depressing' career. I mean, you're dealing with cancer day in day out, it's an uphill battle and most of your patients die very soon. (well, all patients die eventually...still). Why not do O&G? You're dealing with happy patients most of the time, why not right? 

And it's finally my turn to explore this specialty. 

I went to a urology-oncology clinic on the first day, radiotherapy department and the oncology ward (with the palliative care consultant) on the second day. I must say, everyone in oncology is super nice! Way too nice. We, as medical students, are so used to not being acknowledged and ignored in the hospitals and clinics, that when people actually actively teach us and bring us along with them, I feel so 'loved' and grateful. Hehe. 

Today's the third day and I was attached to the early phase (Phase I) clinical trial clinic. I had no idea what doctors actually do in these clinics till I went in. There were 2 consultants, 1 reg and 1 specialist nurse there. 

The nature of the consultations were very different. Instead of the usual consultations where it's patient's health is at the top priority, this consultation serves a very different purpose. It is meant to recruit patients, who have exhausted all other treatment options for their cancer, into clinical trials, in order to test out drugs which has not been tested in human before, but in theory and on animal studies, work. Very often, these drugs do not work and patients suffer devastating consequences and even hasten death. The chances of the drugs actually working is extremely small. 

For the benefit of non-medics/statistician/scientist reading:
  • Phase I: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
  • Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.
  • Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
  • Phase IV: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use.

These risks were all explained to every single patient clearly and they were given time to think about this clearly. They were not at all pressured to take up the risk and are free to leave the trial any time they like, and enjoy whatever time they have left in this world. This will after all, most likely, to not benefit any of them. It is all for developing the next therapy, for science, for the future generation. 

3 very different gamblers
I saw 3 patients with the docs, 1 who was about to be recruited, 1 who decided to leave the trial and 1 who has successfully undergone the trial and her cancer is stable at the moment. Each of them came with their close family member, carried very different burdens and had very different emotions. 

"You must help me. You will be my hero," the first patient said the moment we stepped into the room. I could see his desperation, his aggressiveness and his determination to beat his cancer. The doc explained to him all the risk, and he claimed that he completely understood the risks and he's very optimistic about the quality of care he has been receiving so far. He was very eager to be in the trials, regardless of the price he needs to pay, at the last few months of his life. 

"I've talked to my wife about it and I want to be selfish for once. Instead of coming to the hospital all the time, I'd rather go home, have my gin and tonic and be with my family," said the second patient. Good, then that's what you'd do. He left and never turn back. 

'I've been doing very well, but I want to drive!' the third patient, who has her cancer controlled by the trial drug for 18 months now. She's one of the rare ones which trial drugs worked. She looked completely healthy and normal, no one would have guess she battled with cancer before, she's currently on the winning side and who knows when will that drug stop working, or she'll live to her 90s-100s. She has been enjoying her normal life, but the only thing is she lost her licence because she has brain metastases. 

It was a very strange experience for me. These are the patients who were given a chance to gamble with their life. If you win, you'll live longer; if you lose, you'll suffer from the side effects and probably die sooner than what your cancer can do to you.  The oncology team try their best to make the patients' priorities their priority too. However, it's still a gamble. It's gamble with a lot to win, and a lot more to lose. 

Normally, clinical practice is a gamble too, but the stakes are never this high. For each procedure/drug/surgery given, there are risk and benefits, but if the risks are higher than the possible benefits, doctors often would not proceed, for the patients' best interest. However, in this case, you know the chances of losing the game is high, yet you still gamble. Yes, all of these are ethical, but it is still a gamble. The only thing is, as a doc, you don't lose much if you lose. You feel sad, guilty, go home and cry, the next day, you come back to work and move on.

And such is a doc's life? I have yet to experience this 'gamble' because as medical students, we are purely observers. I don't know how I'd feel on the day I'm actually on the table, with people's lives as my stake, against fate/life/jack the ripper. Maybe I'll be a risk taker who's ready to advance our medical field, but maybe, I'm just that risk averse and scared that doing a phase I trial will never be my thing. 

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