Medical oncology and I share a special relationship. I believe that it can be truthfully described as a love-hate relationship. “Love” days outnumber “hate” days. When patients are maintaining remission, responding to treatments, or when some scientific progress has been made and a new working drug has been approved, it is a love day. Hate days are fewer, but when they strike, they are heartfelt ones.
Consider, for example, a young woman who was diagnosed as having recurrent breast cancer with lung and bone metastases soon after the initial diagnosis. Treatment with chemotherapy was initiated, but she developed severe and persistent thrombocytopenia. Bone marrow biopsy showed near-complete replacement of hematopoietic elements with cancer cells and fibrosis. A computed tomographic scan of her chest and abdomen showed worsening lung and new liver metastases. Her failing bone marrow made chemotherapy risky and impossible to administer, but other treatments to palliate her bone pain and shortness of breath were offered.