Friday, September 29, 2006
Doctor, Does This Mean I'm Going to Starve to Death?
Anyone reading my earlier postings knows that nutrition is a big concern for me. I know that we literally are what we eat - and that if we don't eat, we, quite simply, aren't. So a comment made by my physician this week took me aback, and gave me much to consider.
I went in to talk with him about possibly beginning IV nutrition (TPN, for total parenteral nutrition) for a month or so, because I have had difficulty getting enough calories in the last couple of weeks while waiting for the clinical trial to begin. Despite that, although I have lost some body mass, luckily I had fat stores, so a lot of my calorie deficit was made up from those, and I have not had a big weight loss.
My physician said "Being malnourished is a given for women with ovarian cancer who have been battling it as long as you have and still have extensive disease. However, studies have not shown that doing TPN will change the outcome." TPN, he reminded me, is a rich culture medium for bacterial growth because of the protein and other nutrients. When people do TPN long term they are usually at home and therefore even less likely to maintain sterile conditions than in the hospital. Another factor, he reminded me, is that I'll be going under the care of another physician for the clinical trial, and she should be involved in the decision.
These were all valid points, and I had to agree with his reasoning - for the time being. I did do some investigation to see what the literature says on the topic and found some great articles in the Journal of Clinical Oncology under the "Art of Oncology: When the Tumor is not the Target." Here is a quote from one of the articles:
In the meantime, while waiting to see if the clinical trial will be completely successful in reducing my tumors, I don't plan to starve to death . If it looks like that may be a possibility, I will definitely be taking up the issue of TPN again!
Link
I went in to talk with him about possibly beginning IV nutrition (TPN, for total parenteral nutrition) for a month or so, because I have had difficulty getting enough calories in the last couple of weeks while waiting for the clinical trial to begin. Despite that, although I have lost some body mass, luckily I had fat stores, so a lot of my calorie deficit was made up from those, and I have not had a big weight loss.
My physician said "Being malnourished is a given for women with ovarian cancer who have been battling it as long as you have and still have extensive disease. However, studies have not shown that doing TPN will change the outcome." TPN, he reminded me, is a rich culture medium for bacterial growth because of the protein and other nutrients. When people do TPN long term they are usually at home and therefore even less likely to maintain sterile conditions than in the hospital. Another factor, he reminded me, is that I'll be going under the care of another physician for the clinical trial, and she should be involved in the decision.
These were all valid points, and I had to agree with his reasoning - for the time being. I did do some investigation to see what the literature says on the topic and found some great articles in the Journal of Clinical Oncology under the "Art of Oncology: When the Tumor is not the Target." Here is a quote from one of the articles:
Although most patients with advanced, metastatic cancer will not derive any survival benefit from artificial nutrition, certain exceptions do occur. Patients with inoperable, malignant bowel obstruction, a lack of symptomatic involvement of critical organs (eg, brain, liver, or lung), a relatively indolent course of disease, and a good performance status can have prolonged survival with the use of enteral or parenteral nutrition. However, these patients represent a small subset of patients with advanced cancer. The use of artificial nutrition in patients with advanced malignancy should be considered only under exceptional circumstances."
In the meantime, while waiting to see if the clinical trial will be completely successful in reducing my tumors, I don't plan to starve to death . If it looks like that may be a possibility, I will definitely be taking up the issue of TPN again!
Link
