J Palliat Care. 1998 Winter; 14(4): 55-9.

Integration of palliative care with alternative medicine in patients who have refused curative cancer therapy: a report of two cases.

Jenkins CA, Scarfe A, Bruera E.

Palliative Care Programme, University of Alberta Hospital, Edmonton, Canada.

This article describes two young, potentially curable patients who chose a course of treatment that ultimately resulted in death. Their choice was in part influenced by the prospect of the disfiguring surgery that would have been required for cure. In the first patient this would have meant massive head and neck surgery, in the second, a radical hysterectomy that would have resulted in surgical menopause. The availability of practitioners who promised an easier cure was also a factor in swaying the first patient away from truly curative therapy. Denial also played a role in both of these patients' decisions. Part of their denial may have been exacerbated by the fact that both of their cancers have as risk factors behaviors that the patients may have considered inconsistent with their value system. In the first type of cancer, alcohol and chewing tobacco are major risk factors (11), neither of which would have been acceptable to the patient's family. In the second type, multiple sexual partners are a major risk for cervical cancer (12), a behavior which is inconsistent with the teachings of the patient's fundamentalist Christian beliefs. The approach that we have described--expressions of respect for the patient's belief system combined with the nonconfrontational offering of treatments with immediate symptomatic benefit--resulted in the development of an effective working relationship between patient, family, and palliative care team.