Is This What They Mean by a “Pyrrhic Victory”?
This just in from the frontlines of basic science:
Lung cancer cells grown in vitro are protected from apoptosis (the process by which damaged cells commit suicide) induced by chemotherapy when nicotine is added to the cells.
Adding a small amount of nicotine to the cells increased the activity of two genes capable of stopping the natural death process of apoptosis. Without nicotine exposure the genes were suppressed and the cells successfully completed apoptosis (also known as being blown to kingdom come).
The study authors therefore warn that lung cancer patients who continue to smoke may have a lower probability of responding to chemotherapy. In fact, they state “Our findings are in agreement with clinical studies that patients who continue to smoke have worse survival profiles [my italics] than those who quit before treatment.”
Worse survival profiles? Compared to what? Take a look at this graph which shows the survival curves of advanced non-small cell lung cancer patients who receive chemotherapy compared with those who receive only supportive care. How can a “survival profile” get much worse than this? In fact, the last time I saw a slope this steep I think I screamed like a banshee and wet my britches.
I always tell my lung cancer patients that they will tolerate their treatment better if they stop smoking, but as far as increasing their chances for long-term survival by stopping all nicotine consumption - don’t make me laugh, let alone pull out my little friend and start blasting.
This research is extremely raw and may not apply to living, breathing human beings, but until I see results from actual clinical trials I am not going to rant and rave at my patients who choose to continue to smoke. After all, as Petrarch said:
“Vos vestros servate, meos mihi linquite mores,” which translates loosely as “Shadduppa yo face.”
Thank you for treating the patient, not the disease.
You know, my mother is 91 and has dementia. Her doctor noticed that at 91, her cholesterol was hovering around 300 and put her on lipitor and referred her to a cardiologist. What this meant in real life was that he put her on a drug that would cost her a $1,000 a year and that I took her to a place she had never been, for reasons she couldn’t understand, to have an exam she didn’t understand. The cardiologist found out that she had no symptoms of heart disease, no shortness of breath, no pain, nothing. He was furious and he said take her off the lipitor, have her take a baby aspirin every day, and if she has any symptoms of heart related problems, call him.
I thanked him for treating my mother instead of her cholesterol test numbers.
Telling people who are going to die not to smoke seems to me to miss the point. Thank you for treating your patients.
Comment by Maureen McHugh — April 7, 2006 @ 7:48 pm
My mother-in-law responded unbelievably well to chemotherapy and lived 2 1/2 years following her initial diagnosis of oat-cell carcinoma of the lungs. She said, “When the doc says I’m down to two months to go, I’m smoking again”. Well, one day her kidney and liver functions would allow no more chemotherapy and after sitting in front of a tumor board, she was told there was nothing more that could be done. She began smoking and enjoyed every minute of it and was never on a bit of oxygen until two weeks before she died six months later. She was 59 years old.
Comment by Kim — April 9, 2006 @ 8:01 am