Today I listen to a teleconference sponsored by the Leukemia and Lymphoma Foundation. This is another in their series of helpful educational events, whereby a couple thousand people listen in on their telephones, through a conference-call link, to a talk by a cancer expert. Questions and answers follow. Today’s speaker is Armand Keating, M.D., Professor of Medicine at the University of Toronto. His topic is “Stem Cell Transplantation: Current Trends and Future Directions.”Lest that topic sound dry and academic, let me remind you that, for people like me who may have to have a bag o’ stem cells dripped into our veins someday (or not), the subject has a certain amount of, shall we say, existential interest.
Anyway, one of the items most relevant to my situation came up during the Q&A time. Someone called in, saying he has transformed follicular lymphoma (like me), is in watch-and-wait mode (like me), and may have to have stem-cell transplant someday (yeah – you guessed it – like me). He was asking Dr. Keating to explain some of the factors the docs ought to take into account in deciding when it’s time to recommend a stem-cell transplant.
As you can imagine, the answer to that question is of more than passing interest to me.
Dr. Keating listed the following factors oncologists and their patients ought to consider:- the patient’s age
- the nature of the follicular lymphoma
- the responsiveness of the disease to conventional treatments
- co-existing medical problems the patient may have
- whether the patient is prepared to accept the long-term ambiguity of a chronic condition.
That last phrase, “long-term ambiguity,” strikes a chord. That’s the story of my life right now, I think to myself. I’m living with a lazy cancer that could be life-threatening, but that’s not immediately dangerous. It’s out of remission, but “stable.” It hasn’t grown in 6 months, but it hasn’t shrunk, either. Should I act calm, or worried? Should I press for further treatment, or just sit back and see what happens next? Can I get on with my life, or should I stay in some sort of holding pattern indefinitely? Yeah, you could say “long-term ambiguity” describes it.
Decision-making, in such circumstances, is like trying to nail the proverbial jello to a wall.
It’s interesting, to me, that the doctors have even figured this capacity for hanging around, cooling our heels, into their treatment protocols. “Does this patient have the nerve to wait around, doing nothing, for what could be a very long time?”Turns out you can nail jello to wall. It’s called living with an indolent lymphoma.
