Dose response

We had some bad news yesterday. One of our clients has had some negative test results. This client has an aggressive cancer for which the only available treatment is palliative chemotherapy and radiation when the cancer gets bad enough to interfere with quality of life. So far our patient's quality life has been near-normal, but the test results gave us all a bit of a jolt.

This being a serious cancer, we were seeing the patient 4 to 5 times a week up until mid-December, when holidays and inclement weather began to cut into the frequency of the treatments. The November test results were still fine, so I have to assume that cutting down on the frequency of treatments was the reason for the deterioration.

This brings up the issue of "dose response". Just how much treatment do you need?

Although Bill says in the workshops that serious, metastasized cancers need a lot of treatment, up to even hours a day, one can still manage to come away thinking that this somehow ought to be fast and easy. At the beginning I was wildly optimistic about treatment time. Now I am more realistic, but I still don't know how much is enough.

Last summer I was treating someone for lymphoma once a week. I had a sense that the weekly session was the bare minimum, but the patient was not ready to commit to more. Sure enough when we skipped a week the lymphoma "acted up". The patient then terminated treatment because it "didn't work", even though test results showed that the lymphoma had gone from "grade 2" to "grade 1" (for some reason the improvement was dismissed as a fluke).

Bill has done experiments with mice on dose response. He has found that with weekly distance treatments 40% of the mice still survive. (Here is a link to a brief commentary on the study by one of the researchers, providing a few more details.) In Bill's initial experiments the mice received one hour of treatment a day for about 35 days. The speed of remission was found to be a function of metabolic rate: the larger the animal, the slower the remission. People are a lot bigger than mice. Once you start treating someone, chances are you'll be treating them for a long time.

Since I've been thinking of this method in terms of "standard of care", the sheer amount of treatment time needed seems to be an obstacle. With today's treatment methods, patients get hooked up to IV-lines dispensing chemo, and little manpower is needed to monitor them (I am assuming, rightly or wrongly, that one oncology nurse can monitor 3 or 4 patients -- please correct me if I'm wrong). Sometimes chemo is just a question of popping a little pill. In contrast, with Bill's method treaters would need to spend hours providing one-on-one care. On the upside, however, we might be dispensing with the need for the kind of care where hours are spent with multiple professionals dealing with a single patient, such as in surgery, or where expensive equipment is needed to provide treatment, such as with radiation. The biggest upside, of course, would be an improvement in the patient's quality of life instead of the dreadful side effects of radiation and chemo. But it's early days yet: so far I'm only dreaming.