Onco-xxx

I have always detested the word “oncology” and its various derivatives, such as “oncologist”, long before I had any understanding of their connection to the real world. It is a family of dissonant sounds that cacophonously rain upon the ears. And resonate within the soul with the ominous tolling of the executioner’s bell. And that was before the suite of words became so intimately intertwined with my life. Prior to this, I have only dealt with surgeons, radiologists, clinical trial investigators, and an endless stream of functionaries stumbling through another day at the office. So you can probably imagine the apprehension and reluctance with which I drove to this morning’s appointment with the oncologist.

With what kind of cheery nonsense would his office be decorated? How do you put a happy face on this job? After surrendering my $10 copay I was given a “health questionnaire” to fill out. Questions like “Are you bothered by people telling you that you drink too much?” What? First of all, I have only one or two glasses of wine a week. Is that too much? And who said that people think or tell me I have a drinking problem? Since when are cancer patients being treated by AA counselors?

I was then led to an examining room. Damn – I wasn’t even going to be able to suffer through this miserable discussion in a real office. Just a walk-in closet containing an industrial recliner covered with the thin, cheap paper that line donut boxes. Great. Thanks for going all out on this party, doc.

But I was pleasantly surprised with the Santa Barbara oncologist that my primary care physician had matched me up with. Direct and matter-of-fact. Readily acknowledges the difference between what he knows and what he doesn’t know, a trait I greatly respect and appreciate. A slightly intense edge that didn't conflict with my own. Two peas in a pod. Except that he was wearing the obligatory white coat and I was festooned in an ensemble of tumors.

Like all these guys that are forced to cram too many patients into a Thursday morning, he was overwhelmed by my medical records, a stack of papers that is quickly approaching the Manhattan phone book in terms size, weight, and tedium. So we resorted to the now familiar oral summary. I love it when these guys take notes during my lectures. Or maybe they’re just drawing caricatures, I don’t know.

He echoed a sentiment I’ve previously heard: the tumor in my heart is the biggest concern. I used to think that metastatic cancer in the lungs and bones was a big deal. But these guys just gloss right over that, not even bringing it up unless I do. They are singularly focused on my heart. He expressed a lack of knowledge regarding the success with which this can be surgically resected, and said he would speak with his cardiologist colleague that had read my echocardiogram (remember the “13 cm, uh make that 3.5 cm”, “left atrium, no wait a minute, I think that’s the left ventricle” guy?). As politely but firmly as possible, I indicated that that conversation would be for his edification only and that I would confer with a cardiac expert in San Francisco regarding that question. The blank expression on his face suggested that he might be a good poker player.

He concurred that a systemic approach is necessary, but acknowledged that standard chemo agents are largely ineffective against liposarcoma. We discussed the three clinical trials under consideration. I told him that LA1 had said that their preliminary results indicate tumor stabilization or regression in 30-40% of patients. With a wry smile he asked if I inquired as to what journal that is published in. I reiterated that these are in-process clinical trials and asked him to explain.

He said that a success rate as high as 40% would be cause to stop the clinical trial and make the drug available immediately. He explained that the early anecdotal results with clinical trials are often impressive during the patient recruitment phase, and then somehow are not sustained through the end of the trial. You don’t have to be an expert to read between the lines on that one.

We discussed conventional chemo again. He stated that with the poor success rate in treating liposarcoma, the question needs to be addressed as to whether the disease is worse than the treatment. Like I said, I like the way this guy thinks. So he basically left the door open for making a case for any approach from doing nothing to doing heart surgery only to doing chemo only to doing both chemo and surgery.

And then the million dollar question:

Paul: “What kind of longevity expectancy data can you provide? Not that I'm going to chart my course by it.”
Doctor: “There’s no way to predict this. It’s not like liver cancer where we can chart the trajectory and predict a schedule. In addition, the tumor in your heart could disrupt the conductive pattern of your heart and place it in arrhythmia at any point. So in this case more than any other case I get to evade that question.”

Yep. I really like this guy’s style.

I set up an appointment to meet with him again on 9/30 after my 9/25 appointment with LA2 to discuss their clinical trial. All in all, ten bucks well spent.

Meanwhile, I continue to consume copious quantities of that wretched Chinese "tea" . . .