Lessons From DeVita’s “Death of Cancer”

What practical advice can a common-sense senior glean from Vincent Devita’s book, The Death of Cancer? DeVita doesn’t shy away from the practical side of things — in fact, he devotes his final chapter, Outrageous Fortune, Part II (Part I was about a friend) to describing how he dealt with his own prostate cancer diagnosis.

One lesson from that chapter is that the person receiving the diagnosis is not in a good position to be making decisions alone. Someone newly diagnosed is going to be anxious and worried, and won’t be hearing everything the physicians have to say. DeVita himself, a world renowned cancer treatment expert, found he wasn’t thinking clearly and had to turn to a friend, another world renowned cancer expert, for guidance in his decision-making.

The problem is that most of us don’t happen to count cancer experts among our friends. So let’s hope that when the time comes, we have a doctor we trust as well as friends and family who can support us emotionally and even help us with our research.

Research is going to be necessary. DeVita has a rather disturbing few pages on the best places to go for the treatment of various types of cancer — and it’s information that the lay-person would be challenged to discover. Fortunately, DeVita assures the reader, “the United States has the best cancer care in the world. Not all patients receive their care at cancer centers, nor do they need to. Much of cancer care can be delivered at community hospitals.”

But someone diagnosed with an unusual cancer, an advanced cancer, or a type with a poor survival rate, should be at a center, DeVita writes, that is “cutting edge” and practicing “state of the art” cancer treatment and management.

How do we find such places? DeVita has his recommendations, writing that the National Cancer Center in Bethesda, the Dana-Farber Cancer Center in Boston, and the Stanford Cancer Institute are the best places to go for treatment of lymphomas. DeVita goes on — “Yale may be the best place to go for cutaneous T cell lymphomas but not for any other type.” “The Mayo Clinic is good for state of the art care for common tumors, but I wouldn’t send someone there who needed something creative or inventive.” “The best place for adult leukemia therapy is MD Anderson in Houston, Texas.”  You can read other such recommendations on pages 238-239 of DeVita’s book, but it’s time-sensitive advice. As time passes, some centers will improve and others may decline.

Anyway, how is a lay person to find out which is the best center for his or her particular situation? That’s where the research comes in. It’s going to require asking a lot of questions, doing a lot of internet research, and perhaps, as dear friends recently did, traveling to potential treatment sites to form your own opinion.

DeVita favors centers that devote themselves exclusively to treating cancer patients to university-based centers with a variety of other priorities. He advocates aggressive treatment over treatments that may leave the patient more comfortable, but have, in his view, little chance of success. And he wants patients to have access to the latest and best approaches, such as combination targeted chemotherapy and immunotherapy. There might be a new treatment available now, he argues, that will enable a patient to survive for several years, when something even better may have come along to give still more years of life.

DeVita’s book has certainly convinced me that advanced, aggressive treatment at the best possible facility would be worth a try. Whether I would still feel that way should I live into my eighties is a question, though I would probably still give a first round of treatment a shot. Maybe by then, cancer will have been well and truly conquered, though I doubt it.

 

 

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