Measuring status without scans

"Without scans, how will we know how I'm doing?"

For years, she'd known the answer by reviewing her test results with her oncologist. When she made the wise—and difficult—decision to stop all anti-cancer chemicals that were no longer helping (and now causing harm), the testing stopped, too.

She cried, "How will we know what's happening or what to do?” The uncertainty was excruciating. I explained how her palliative care physician uses a different paradigm to assess her condition and determine how best to help.

“The ‘test’ is how you feel," I said. "Can you eat? Sleep through the night? Go to the bathroom? Is your pain managed well enough to enjoy your drawing? To enjoy reading with your grandson?"  

"Why not get scans, anyway?"  

For years, those useful diagnostic tests helped her survive. Now they're useless, and they risk causing harm. While seeing stable disease would buoy her spirits--a good thing, "good news" results wouldn't help her oncologist optimize her therapies. The risk is finding evidence of increased disease: That news would make it more difficult to enjoy today, even if she felt well today. Those results wouldn't help her doctors improve her care, either.

How you are doing tells us how you are doing," I told her.  "Your description of your life between visits helps your doctors optimize your therapies." Those effective comfort therapies empower her to be a Healthy Survivor and live as fully as possible each day.”

Next: Healthy Survivors and the “test” of "How are you doing?" 

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