Do you always have to do what the doctor says? Part 1: When the answer is YES

Brass Balance Scales

Balanced decisions require weighing all factors.

Don’t get caught with your scales tipped.

The answer is YES if you are getting radiation therapy for uterine (endometrial) cancer, breast cancer, or any other cancer. Once you make the decision to undergo this treatment, don’t give up partway through—persevere until you have received the full dose. See the end of the post for when the answer may be NO.

Recently, I heard from two women through the blog, both of whom had essentially the same diagnosis and treatment that I had—that is, uterine (endometrial) cancer requiring total hysterectomy and vaginal radiation, or brachytherapy. And both said that they considered stopping radiation after the second of three treatments because of side effects.

The first woman persevered with her vaginal, bladder, and bowel issues and completed her third treatment after her doctor told her that she “would just end up with the side effects and possibly not protect [her]self from cancer relapse.” In other words, stopping after two treatments would have meant getting only two-thirds of the full radiation dose of 21 Grays (Gy), 7 Gy per treatment (see the February 20, 2014 post), and this might not be enough to kill any microscopic cancer cells that might still remain in her vaginal vault.

The second woman had completed two treatments and, as of last week, was considering not having the third because of side effects, in her case, bladder issues. She said her doctor had not prepared her for this. I am hoping that she will complete her treatment for the reason stated above. Why suffer side effects and not get full benefit—and possibly increase the risk of recurrence? So, do you always have to do what the doctor says?

As I’ve said many times in this blog, I am not a medical professional and do not dispense medical advice. But I can share experience, thoughts, and information. In the case of completing radiation therapy for cancer, my opinion is YES—once you decide to have the therapy, you should do what the doctor says and complete your treatment.

Do Your Homework First—Then Make Your Decision

Much, and almost all, of the information I provide in the blog is available on the Internet, but it can be tricky to track down and distill this information into a coherent package of usable resources. Frustratingly, a quick pre-post Google search today did not turn up much information on patient compliance with radiation treatment. But I did find two breast cancer sources that encourage women to complete their radiation therapy:

“The benefits of radiation strongly depend upon getting the full recommended dose without significant breaks. These two elements of your treatment plan are vital because:

  • The full dose of radiation is needed to get rid of cancer cells remaining after surgery.
  • Radiation therapy is most effective when given continuously. . . .”

Susan G. Komen:

“. . . [R]adiation therapy is most effective when you finish the entire course.”

Radiation causes the death of cancer cells, either by destroying a tumor or by preventing its recurrence. It also causes the collateral death of normal cells, resulting in sometimes unpleasant side effects. Both cell death and cell regeneration depend on the life cycle of the cell—that is, when it undergoes cell division, or mitosis. This occurs at different intervals, depending on the location in the body.

The National Cancer Institute says:

“Radiation . . .
  • does not kill cancer cells right away. It takes days or weeks of treatment before cancer cells start to die. Then, cancer cells keep dying for weeks or months after radiation therapy ends. . . .
  • not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. The healthy cells almost always recover after treatment is over. But sometimes people may have side effects that do not get better or are severe. . . .”

So it is vitally important to start killing any remaining cancer cells as soon as possible—and to complete the treatment within the prescribed dosage window—before they undergo their next cell division. Similarly, this interval-based mitotic activity accounts for why some side effects occur early in treatment and some much later.

* * *

In summary, according to the best information available, I encourage all women who choose to undergo radiation therapy (or chemotherapy or both) to complete their treatment, side effects notwithstanding. You probably know how important it is to finish a course of antibiotics to be sure the microbes causing an infection are all killed. Completing cancer treatment is pretty much the same idea—the full dose is required to obtain the best result possible. So please, ladies, if you have decided to accept cancer treatment after researching your options, please see it all the way through.

As my doctor said to me last week (see the March 28, 2014 post), second-guessing myself about whether I should have had external pelvic radiation in addition to vaginal brachytherapy at this point is moot: the window of opportunity to do any other, or further, radiation treatment is now closed. Please be sure you’ve “cleared the air”completely before you close your window.

Please refer to the resources below for more information about radiation treatment and side effects. Also see recent posts in this blog about my personal experience with radiation.

When the Answer May Be NO

In Part 2: When the answer may be NO, I tell you the story of a time seven years ago when I listened to a doctor and should not have. I suffered serious consequences for following the advice of an uninformed physician who refused to use the Internet—and later told me he couldn’t even find the name of the tendon that ruptured in my foot in his textbook! (It ruptured because of his prescribed doses of medication.)


Do you always have to do what the doctor says?

Part 2: When the answer may be NO

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