Ten years ago, a young woman in desperate need came to my office. I am now dying from cancer.Her story was amazing. As a door prize, she won a special blood test at an integrative medicine seminar. She had planned to have some bloods done, so she took advantage of the offer. However, she was called by a doctor who told her that she had cancer. Her skeptical cousin asked why no one had ordered a CT scan. The scan revealed two small lung nodules. She convinced her GP. She was referred to a surgeon by her GP, who performed a second scan. The benign nodules were gone. She believed the surgeon, but he claimed she didn't have cancer. She then saw me.You have to help me find cancer.Her unfulfilled desire was both troubling and alarming after months of expensive private consultations. She was a mother of a newborn who wanted to live. Isn't early detection of cancer the holy gold? It was easy to dismiss my daughter as anxious. But, it was wrong to help her understand what had actually happened.I was stunned when the patients agreed to write a cautionary essay for the New England Journal of Medicine. It was the first time in my writing career that I had to verify the truth of the story. I said that it was impossible to conjure it with any feverish imagination. Who gives away a blood test for a door prize?Although the patient received a test based on a clever principle, many doctors had never heard of circulating tumor cells. These are tiny fragments of cancer that have been introduced into the bloodstream. A simple blood test for these cells can identify asymptomatic and operable cancers, as well as determining recurrence risk, thus stratifying the need for chemotherapy.Although there are reasons to be optimistic, researchers warn that measuring circulating tumor cells is still an experimental technique. It is clear that there is enough uncertainty to warrant the need for randomised, laborious studies in order to confirm both clinical and analytical validity of the tests. Also, just because you can measure something, doesn't mean it is useful. A new test won't be better than the one that was previously used.From their own experience, doctors know that even people who are struggling to pay for food can still manage to make ends meet if they are told it will help with cancer. Oncologists are dismayed at yet another offer that is not approved and presented to patients as hope, in light of the recent news about circulating tumor cells resurfacing.While we are improving in treatments, we are still not able to provide comprehensive care for patients.Patients who are hapless are expected to pay for an unproven test. They also receive controversial advice. The patients are then asked to consult their oncologist. This is intended to be a reassuring sign that we all are in this together. Cancer patients require all the support they can get, but this is not one of them.Although chemotherapy can be a dangerous and blunt tool, it should be used sparingly. However, certain treatments can prolong the quality and duration of life. For an oncologist to have an informed conversation about how to avoid chemotherapy is one thing, but for him to push to use a non-validated and unproven test to do so raises serious ethical concerns. Our patients deserve better.It might seem reasonable to suggest that an oncologist should not be required to perform a test just because it was done. Patients don't think this way. Imagine putting your hopes and savings into a test only to be told to ignore the results. You could spend thousands on vitamin infusions as an alternative medicine staple only to discover that the vitamins actually flushed out any cancer.My young patient was unable to believe that she wasn't terminally ill despite receiving spurious results. I was now charged with proving that she didn't have cancer. It was my responsibility to convince her that she should enjoy her child and not be ruled by fear of death. After spending as much time with her as possible, I had to tell them that I simply couldn't have room in my clinic for patients with cancer. Although she graciously accepted, I have never heard from her again. However, I will always remember her terrified face.Oils, potions, and other promising, but not proven therapies, will continue to exist as long as there's a market. We can reduce fragmentation in healthcare so that patients with cancer receive all the information they need in one place. While we are improving in treatments, we are still not able to provide whole-patient care. Although they know their chemotherapy schedules by heart, patients still have questions about what to eat or how much exercise to do. Patients don't know who to confide in or if asking probing questions is a sign of disloyalty. They need someone to help them when they leave the doctor's office. A cancer care nurse is an additional person who can help the patient. However, such nurses are rare.It is easy to see why so many people chose to travel the path of questionable treatments. The final cost of the healthcare system was unforgivable.Professionals find it more embarrassing to see a patient with cancer make their journey unnecessarily harder. We need to ensure that vulnerable patients are protected from unproven or bogus treatments. This requires strong and flexible regulatory oversight. We cannot achieve better communication at an individual level.There are many people who will offer advice to someone diagnosed with cancer. Everyone wants to help, from the second cousin of the neighbor to the natural healer. Overwhelmed patients will listen to those who sound the most convincing. It is the real task of medicine to earn the trust of patients. They will listen to their doctors and nurses rather than those who promise the world but deliver very little.
