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The Artist in Cancer Treatment

It was important to have an artist do your treatment, because so much was at stake, namely the balancing of cure on one hand and life changing side effects like incontinence and impotence on the other hand. It made sense to me. Instinctively everyone wants the most skilled person possible performing their cancer treatment.

Then I encountered some anger on the same website over the term artist. It was too wishy-washy, expressing something beyond the scope of science and standardized methods. Patients who had not traveled across the country to seek out an “artist” wanted to believe that the results were the same from clinic to clinic as long as standard treatment methods were used. Everyone wanted to believe that they chose the best treatment possible for their cancer; no one wanted to think they would have been better off if they went somewhere else.

But I believe more than ever that there are artists out there, experts who rise above the normal skill levels. I also believe that it can make a fundamental difference in cure rates and side effect rates.

There is a strong correlation between cure and side effects. If you want to improve the chances of curing a tumor, you can do so by giving a higher dose of radiation, radiating a wider area, doing a more extensive surgery, or giving a more toxic dose of chemotherapy. All of these will in turn cause more side effects. But what if you could make these treatments smarter instead of stronger? Put the higher dose of radiation directly into the tumor. Know exactly where the tumor may be sending out prongs of cancer cells and cut exactly around those. Use a combination of treatments in the right proportions instead of a single treatment. By being smarter, you can improve the cure rate without worsening the side effect rates. This brings me to my law of treatment intensity:

Any attempt to increase the cure rate of a treatment will also result in increased side effects, unless there has been an increase in tumor targeting through technology, resources, and/or expertise.

The trick to being smarter is to be able to be more accurate in targeting the tumor with your treatment. This is not always easy. Tumors are rarely completely separated from the normal tissues. They usually invade, and sent out invisible fingers of cancer into the surrounding organs. Tumors often have vague edges which blend into the body’s normal tissues. Treatments that are more anatomically targeted suffer from increased difficulty in knowing exactly where to aim the therapy. It is always simpler to radiate a large area than it is to radiate a tiny area that conforms more precisely to the tumor. It is easier to get all the cancer by removing an entire breast than it is to remove just the lump with just enough surrounding tissue.

This is where the expertise comes into play. An artist may have a heightened ability to know where the tumor is, where it may have spread to, and what the boundaries are between normal and cancer. He can recognize the anatomical configuration the cancer is taking in the body. He secondly has the ability to deliver his treatment as cleanly and precisely as possible to the affected area. He uses a treatment intensity that is matched to the aggressiveness of the cancer.

Artists are by definition the cream of the crop. They surpass the average. This means that not everyone can be treated by an expert, there simply aren't enough to go around. They are harder to find -- you need to ask opinions, check out the internet, articles, and books. But they can be found, as an individual you can be treated by one.

Notes are written by Dr. Doug Kelly, unless otherwise stated. These reflect my own opinions and not necessarily those of CTCA or my colleagues.