The Cheerful Oncologist

Teen can opt out of chemotherapy.

The 16-year-old Virginia boy may undergo radiation and alternative treatments.

This story has been reported before by Orac and others, but I just wanted to add a couple of highly biased comments to the latest development in the case of a teenager who took chemotherapy for Hodgkin lymphoma, had awful side effects, then suffered a relapse and refused the advice of his medical oncologists, which was to undergo high-dose chemotherapy followed by a stem-cell transplant, which of course is one of the standards of care for relapsed Hodgkin lymphoma in a young patient.*

The family of a Virginia boy who has refused conventional medical treatment for cancer reached a settlement Wednesday with state officials, agreeing that he will see a new doctor while continuing his alternative therapy.
The compromise means that Starchild Abraham Cherrix, 16, will not have to undergo chemotherapy against his will, as a judge had ordered him to do.

I sympathize with Mr. Cherrix’s plight and understand perfectly why he would refuse going through a stem-cell transplant. His choice of alternative treatment, however, leaves something to be desired in my opinion:

The boy and his parents prefer the alternative - the Hoxsey method which uses herbal medicines, nutritional liquid supplements and a largely sugar-free, purely organic diet. The Hoxsey tonic, required in this method, is banned in the US but available in Mexico.

The Hoxsey treatment? For Hodgkin lymphoma? I’d be willing to put chemotherapy up against the Hoxsey tonic at any time and see which method produces the best outcome.

Say, what do I mean by outcome anyway? Well, if the outcome entitled long-term survival is what is desired by the patient, then conventional anti-cancer therapy in my opinion has the best chance to achieve this. If the patient is willing to accept the possibility that death from progression of Hodgkin lymphoma is more likely to occur with an alternative treatment, then I have no problem with the patient rejecting my therapy. One of the differences between conventional anti-cancer therapy and “alternative” therapy is that when I counsel patients about the risks, the side-effects, the possible benefits, the long-term effects and the possible outcomes of chemotherapy or targeted therapy, I know what the data are and I am not afraid to share it. For better or for worse, the treatment speaks for itself – I have nothing to hide, and no false hope to sell to the desperately ill. Don’t get me wrong – I try to sow optimism and hope in the barren field of despair, but as far as facing unpleasant realities, such as treating incurable cancer, or using chemotherapy that has horrible side effects, my motto is:

“Let the truth be your guide.”

I wish Mr. Cherrix nothing less than the total cure of his Hodgkin lymphoma. Just don’t make the mistake of blaming a bad outcome on sincere medical advice.

[For a description of some of the standard medical options for the treatment of relapsed Hodgkin lymphoma, please read the footnote below.]

*The selection of second-line chemotherapy regimens depend on the pattern of relapse and the agents previously used. Some studies suggest that late relapses (selected patients) can be successfully treated with the same regimen used for initial remission induction with favorable results if a second CR is achieved. Induction failures and early relapses will require chemotherapy regimens composed of agents not previously used before treatment with high-dose chemotherapy with stem-cell rescue. Some of the regimens previously evaluated are: Mini-BEAM, MINE, VIM-D, and EVA . Some studies have suggested that patients with minimal disease burden at relapse (not refractory) may not need additional treatment prior to high-dose chemotherapy with stem-cell rescue. However, patients tend to have an improved outcome when transplanted in a minimal disease state. Thus, cytoreduction with chemotherapy (see above) before high-dose chemotherapy with stem-cell rescue may be beneficial. In addition, salvage chemotherapy serves as a test for drug sensitivity and to facilitate the harvest of stem cells. Some studies suggest that nitrogen mustard, procarbazine, carmustine, and melphalan may adversely affect both quality and quantity of stem-cell collection.

Examples of salvage chemotherapy prior to transplant include ICE (ifosfamide, carboplatin, etoposide), DHAP (dexamethasone, cisplatin, high-dose cytarabine), ESHAP (etoposide, methylprednisolone, high-dose cytarabine and cisplatin).

Comments

  1. #1 Pat
    August 17, 2006

    I guess the bigger issue is whether a 16yo has the same right as an 18yo to refuse a potentially lifesaving treatment in favor of no treatment or palliative treatment. If it were posed in that light, it would not concern me, and if the 16 yo was more mature than immature, I would say likely yes. However, it was clear (to me at least) that this 16yo truly believes in the alternative method, which squarely marks him as in denial, and probably not capable of making an informed choice. That this belief in unproven alternatives (or, more truthfully, alternatives that have been proven NOT to work) is also held by his family and sizeable numbers of Americans is a sad comment on our inability to educate the lay public.

  2. #2 Bridget
    August 17, 2006

    As usual, a most thought provoking post.As both a current cancer patient and a retired hospice RN, I couldn’t agree more with your position.It also brings to mind a current argument against the death penalty (and other extremely harsh sentences) for teenagers;those in favor of the abolition of such sentences argue that the brains of teenagers are not yet fully developed and thus such youngsters are unable to fully appreciate the consequences and ramifications of their actions.It would seem logical to extend that argument towards not allowing minors to make such sweeping decisions on their own regarding their medical care.I also concur with Pat( above) that this is indeed a sad commentary on our inability to educate the lay public. I do so wish that the public would quit getting their health care education and information from television shows like E.R., House, Chicago Hope and a host of other shows ad nauseum.Thank you for all that you do to keep so many from their own folly!

  3. #3 emmy
    August 17, 2006

    I haven’t been following the news for almost a year now, so I’m making assumptions based on what I’ve read here. To me the biggest issue is whether or not the parents have the right to seek alternative methods of healing for a minor child. Don’t get me wrong, I don’t agree with the method they are using. However as a mother and a cancer survivor if I had to make that decision, I’d want the right to disagree with my child’s doctor even if it meant that my decision was wrong. I don’t want my pediatrician or the state telling me that I have to follow a certain treatment plan.

  4. #4 Peter
    August 18, 2006

    Chemotherapy isn’t a blood transfusion. With Abraham Cherrix they had four options:

    1) Convince him that chemotherapy is the best way to go. They tried this and it didn’t work. At this point he is so convinced that additional chemotherapy will kill him that further attempts may be fruitless.

    2) Put him and/or his parents in jail until Abraham agrees to comply with the chemotherapy. As a free society I just don’t think were ready to open that Pandora’s box.

    3) Shackle him to the hospital bed and administer chemo against his will. My initial thought would be that this would significantly lower his survival chances. It may also be completely impractical.

    4) Do what they did, and require him to explore every treatment option except for chemotherapy.

    It really doesn’t matter whether Abraham Cherrix is mentally competent to make this decision. He’s physically capable of making it and is at least mentally competent enough to resist attempts to coerce him into undergoing the chemo.

  5. #5 Chris
    August 19, 2006

    What kind of failure of society are we experiencing where this kind of decision is becoming accepted practice?

    My mother was diagnosed with cardiomyopathy while I was in high school. She survived despite being minutes from death for her week-long stay in our local hospital. Ok great, she’s a little fatigued from what she went through, no biggie. Fibromyalgia and lupis didn’t help but she’s now some semblance of healthy.

    Then she informs me that she might have breast cancer. “Might” turned quickly into “did” and here she now sits the product of surgeries, massive amounts of drugs, chemo, radiation, prayer and some luck (not to mention skilled medical practitioners). She’s alive 4 years after cancer stripped her of her right breast and 5 years after her heart returned to normal size. If she’s lucky she can make dinner for our family and not pass out from exhaustion. I might be a little tired after my morning run but my mother has to lie down or risk falling down after a quick shopping trip at the safeway down the street. Somehow she runs a successful business making purses off ebay, practices target shooting and on occasion indulges in a bit of fishing.

    How can Abraham Cherrix use chemotherapy as an excuse to make this kind of decision? Mom was 50+ years old when she was diagnosed with cancer. The odds were stacked so far against her if anyone had a reason to quit it was her. Cherrix has no excuse in my opinion. But no my mom is sitting 2 rooms away from me right now busy at work selling purses. Chemo forced her to bed years ago. The person who spent so much time raising me had to now be waited on. A bad chemo session is no reason to wimp out of further treatments that stand a better chance of prolonging Cherrix’s life then an unproven cocktail of tree bark and tomato juice.

    Having said all that I now wonder at a system that allows a judge the freedom to force a teenager who, under the consent of his legal guardians, doesn’t wish to follow the suggestions of his doctors. Is that not what the founding fathers were terrified of?

  6. #6 Kevin
    August 22, 2006

    Two comments:

    First of all, the high financial cost of cancer care means that we shortchange the children. A woman who is 50 and facing death has lived a good, long life. Fifty is terribly old, and the tremendous cost of cancer care means that we can’t feed or clothe our children!

    Secondly, the only way an oncologist can be ‘cheerful’ is if he enjoys delivering bad news.

  7. #7 Leslie Kenyon
    December 12, 2006

    I have a 48 year old girlfriend who is diagnosed with Hodgkins. She is in denial and doing microbiotics diets for cures. In a few short months from her first lump being noticed, she had gone from stage 1 to stage 3. She stopped talking to anyone who insists she get chemo as advised. Her husband of a year also encourages her to ignore the doctors advice. She is getting thin now after a year and I fear she will start getting very sick. Of course she will die if she keeps refusing any treatment. She also claims she wants to live and feels she can by willing herself healthier. This is a intelligent lawyer, by the way, who feels no one else knows her body like she does. We must let her die as we can not force her to get treatment. Her husband won’t allow any interference. So we can do nothing. This has caused her family and friends much stress and feelings of such helplessness watching her slowely die. I wonder if people in denial understand the effect on others they claim they love.

  8. #8 Michelle
    January 21, 2007

    This story makes me crazy.

    Starchild is 16, not 18.

    50/50 odds v.s. certain death? Put the parents in jail when he dies.

  9. #9 Bobbi
    January 30, 2007

    Michelle,

    You are obviously a nosy, busy body that believes you are some higher power that should be able to control other people’s lives. You should be sent to Guantanomo or Iraq just to knock that chip off of your shoulder.

    I am a Hodgkin’s patient, I’ve been through chemo, high dose chemo and one stem cell transplant. Don’t, for one moment, think that some busy-body internet biddy, is going to make MY or my family’s medical decisions for me! This is still America, depsite your desire to allow the Government to control us.

    I would never wish cancer upon anyone, but if I had to choose someone to live in my or this boy’s shoes, it would be YOU. Then you can have other people making YOUR medical decisions for you, while you suffer.

  10. #10 Michelle
    February 3, 2007

    No Bobbi, I’m not a “nosy busy body”. I was a Hodgkins patient with religious freaks for parents.

    Lucky for me I was diagnosed just after my 18th birthday.

    Bobbi, if you’re over 18, make any choice that you think will work the best for you.

    If you’re a child, it is the government’s responsibility to step in and protect you. That is one thing I do want the government to do and I am the strongest supporter of small government that you will ever meet.

  11. #11 Michelle
    February 3, 2007

    Oh and Bobbi, look at it this way. You did retroactively get your wish: I did get cancer and I did suffer.

    Happy?

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