Cancer patients sometimes opt to discontinue therapy


Medicines are getting better and more expensive, people are getting older. But there are also seriously ill patients who refrain from treatment offers.

Rebekah Haefeli

Pia Marolf's husband died of cancer about three months ago. (Image: Annick Ramp / NZZ)

Pia Marolf's husband died of cancer about three months ago. (Image: Annick Ramp / NZZ)

Pia Marolf is packing. In a few days is the reins. Then she moves away from the apartment where she lived for many years with her husband Hans. "He was a well-known personality in Zurich HOngg," she says, leading an electronics store with her husband until retirement. Now the apartment has become too big for her alone. Hans Marolf died in August. Three weeks only after receiving the devastating diagnosis: pancreatic cancer, already with offshoots in various other organs.

The inevitable accepted

"He took it very carefully," says the 70-year-old, sitting at the dining table. "And he immediately said he did not want any therapies. He did not want a life extension, even though he had been offered to do chemotherapy at the Waid Hospital. "Pia Marolf wore it as well. "I accepted it. He wanted it that way, and he was an adult, self-sufficient person. "The daughter, Anita Marolf Steiner, also accepted her father's decision, without trying to persuade him to do anything else. Pia Marolf gets up from her chair, disappears into the living room. When she comes back, she has a calendar and a photo in her hand: her husband Hans and her, arm in arm, in happy days.

Then she leafs through the calendar and taps with her index finger on a pencil entry. «On July 18, he got the result of the investigations. From then on, it went downhill quickly. "Pia Marolf, her daughter Anita and the family doctor turned on the specialist service for palliative care of Spitex Zurich Limmat. Then Doris Kropf was at the door. The nurse took care of Hans Marolf until his last day, working in close cooperation with the family doctor to ensure that he got medication that relieved his pain. She took care of the relatives and talked to them about the end of life. During the night of August 8, the 72-year-old fell asleep forever. His wife had just rushed to the apartment door this minute to let in a nighttime fax employee.

The nurse Doris Kropf says: "Hans Marolf impressed me with his strong will. He knew what he wanted and accepted the inevitable. "So far, she has rarely seen cancer patients decide on the day of diagnosis that they will not seek oncology treatment. Most tried one or the other. "They cling to life, and oncology always has something to offer." Surgery or oncology treatment, such as chemotherapy or radiation, can cure or stabilize the disease if the cancer is found in time. This can potentially extend the lives of patients.

Aggressive cancer

Mr. R., too, has received a whole range of therapy offers from the cancer specialists who look after him. He was also confronted with the diagnosis of pancreatic cancer. That was in June of this year. Mr. R., 76 years old, wants to remain anonymous because he does not want to burden himself even more in his situation. He was on Pentecost with his wife on a mountain hike when he could no longer breathe properly. Other signs that something was wrong, he had not felt before. Half a year before the hike, he had last been for a check with his family doctor. Everything, including blood levels, was still okay then.

"The diagnosis was a hammer blow. I was told that this type of pancreatic cancer could grow very quickly, "says Mr. R. at his home in an outlying area of ​​Zurich. In June he already had an offshoot and water in his lungs; Meanwhile, the liver is affected. He is sitting on a beige sofa; next to it, on a chair, his wife. "Of course, I immediately asked the doctors: What can be done?" Says Mr. R. "Nothing but chemotherapy," the doctors replied. An operation is impossible. Within three days Mr. R. had to decide. He thought: you can try it yes. His wife was of the same opinion; Children do not have the two.

The 76-year-old was fully alive until the diagnosis, he is self-employed, works until today and traveled with his wife around the world. "They had planned a few nice trips", the couple says; but the diagnosis would have shattered these plans. Mr. R. went through six chemotherapy cycles, each for about 14 days, then there was a break. "I was tired and limp, had hair loss and lost the feeling in his fingers." To prevent nausea, he took medication.

Decision to discontinue therapy

The therapy days he experienced as grueling. "I was in hospital, watching for six or eight hours as the fluid dribbled through the tubes." The side effects would have started after half an hour. High fever, diarrhea, even more tiredness. He was given injections for the symptoms. The sixth chemo cycle was followed by a major investigation, "with MRI and all," says Mr. R. The investigation found that the cancer could be kept at bay with chemo; the tumors were not grown.

Nevertheless, Mr. R. decided to stop the therapy one month ago. He felt too bad, no joy in life anymore. "I value quality of life," he notes today, "not for life extension." He had hoped for some of the discontinuation of therapy. He thought that he could go on a few trips with his wife. But his hopes have not been fulfilled. "It's a big disappointment. I have no energy, I'm tired, I do not like to eat and I suffer from insomnia. "He now has" half a pharmacy "at home with medications that make breathing easier, for example.

Mr. and Mrs. R. own a large circle of friends and acquaintances. From the beginning they have informed them openly about the illness and the perspectives. Mr. R. does not conceal the interruption of his therapy either. He has received much encouragement, he says, only between the lines he rarely feels a trace of incomprehension.

Mr. R. and his wife both say they have had a good life and enjoyed it together. That was a certain comfort. Next, they celebrate their 50th wedding anniversary. For both the situation is difficult. He says, "I'm sorry to see my wife suffer. She is afraid of the time when I am no longer there. I understand that well, and it puts a lot of strain on me. "Ms R. is brave and does not express much emotion in conversation. "We know that our time in this world is limited," she notes. "Fortunately, we never postponed anything."

Not afraid of dying

Ms. F. lives in the Zurich region. She is in her mid 80s, has a keen mind and knows what she wants. "I'm suffering from cervical cancer, and that's what I'm going to die of," she observes without batting an eyelid. She was diagnosed several months ago after being hospitalized with severe bleeding.

"The doctors said they could operate and then irradiate. Thinking about it makes me sick, "says Ms. F. The medical team advised her on alternatives, made use of her decision not to use oncological treatment and let fate take its course, but then accepted it. She wanted to think first home and in peace.

"I am a total realist in such matters," sums up Ms. F. "I do not want any therapies other than medication for pain relief. After all, I could not have been cured. "She had never doubted her decision, and nobody had tried to change her mind. Her two children were behind her and of course accepted her decision.

When asked what prognosis the doctors would have made for the course of her illness, Ms. F. shook her head. "I do not want to know about that. I do not believe in medical prognosis anyway. I only hope that dying does not last forever. I'm not afraid of that. »

Individual decisions

Andreas Weber is now – at the end of Mrs. F.'s life – her doctor. The palliative physician is attending physician at the hospital Wetzikon. He sits in an office in the hospital and draws up a syringe with painkillers. He fills a pump with which one of his patients can administer himself a sufficient amount of painkillers. This patient also has advanced cancer and is bedridden most of the time. Weber will bring her the pump home.

The palliative care physician says that patients like Ms F., who deliberately reject oncological therapies, meet again and again. "As a doctor, you should start talking to people about their treatment goal. You have to ask them: What is important to you in life, how happy are you in the current situation? And: how important is it for you to live for a long time? Many patients then say that a long life is no longer so important to them. "Accordingly, one can adapt the treatment and alleviate the suffering, instead of carrying out stressful therapies with strong side effects. These decisions must be made individually and without time pressure.

Andreas Weber criticizes, most of the doctors worked differently, also because of their education; they would not do justice to all patients. "They make a diagnosis and automatically give treatment and therapy recommendations before the goal has been clarified in a detailed conversation."

Frequently, says Weber, there were also no clear decision-making aids, such as simple statistics that could be discussed with patients. "One would have to use a graph to show how many patients with the same cancer, with or without chemotherapy, survived for a certain period of time. Also an honest education about the side effects of a therapy is important. "On this basis the patients could weigh the chances and risks independently.

Partial incomprehension

Hans Marolf from Zurich HOngg, who suffered from pancreatic cancer, did not need any statistics to make that very personal decision for himself. His wife Pia was asked a few times in the three months since his death why he had refused therapies. Not all questioners could understand their explanation right away. For Pia Marolf it was important to see her husband carry his decision to the death without fear of death. "It suited him with the clarity with which he dying." This certainty comforts her today.

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