Is extending life by weeks worth the toll some cancer drugs take? Doctors push for 'common-sense oncology'

Tom Somerville's decision stop medical treatment for his end-stage cancer was a personal one.

Somerville, 62, was diagnosed with colon cancer in 2021 that later spread to his liver. He had six months of chemotherapy to slow down the cancer, which he said also left him exhausted with nausea. 

The Kingston, Ont., resident decided to take a break from treatment to enjoy a trip with his wife to Victoria. 

"Things that you cherish change, right?" Somerville said. "I used to love being out in the bush, but now it is just nice to have a sunny day, sit with my family [and] have visitors." 

Somerville said he came to terms with his prognosis and decided to enjoy the rest of the life he has left, extending the chemo break to a full stop. He said he was relieved to not "feel crappy" from the treatment anymore. 

Dr. Christopher Booth, Somerville's medical oncologist at Kingston General Hospital, supports him in his decision. 

Booth is also part of a group of cancer doctors in Canada and the U.S. who say medications with marginal benefits are overused for patients in the end stage of the disease. The oncologists have started a campaign through their website, journal articles and podcasts encouraging honest conversations about use of the drugs with cancer patients, their families and experts.

The goal of what they call "common-sense oncology" is to prioritize treatments that meaningfully improve survival and quality of life. They aim to address what they see as problems in the field, such as a lack of critical thinking in oncology training, falling standards for drug approvals and avoidance of end-of-life discussions.

Booth said while there have been incredible advances in cancer treatments in his 20 years of practice, there's also an unfortunate reality: cancer can't always be cured. He strives to convey it in a compassionate and clear way. 

"Balancing … providing information but also providing hope, that's the art of cancer care," Booth said. "Balancing hope and reality, balancing treatment and quality of life and side-effects, that's the tough part of this job." 

Booth said he thinks everyone would agree that a treatment that helps a patient live for extra months or years is very helpful. But when a treatment buys weeks with a lot of side-effects, then patient perspectives may differ. 

In part that's because the cancer drugs that can shrink tumours also come with side-effects, including fatigue, vomiting and hair loss. 

Dr. Bishal Gyawali, a medical oncologist and associate professor at Queen's University in Kingston, was motivated to press for changes when he noticed increased spending on treatments that don't make much difference in patients' lives while at the same time agencies didn't put resources to what's already been proven to work. 

Gyawali previously treated people with cancer in Nepal, Japan, and the U.S. and saw the same trends there.