If I had cancer like Ronnie, I wouldn't have chemo either: DR MARTIN SCURR on why the side effects of the treatment can destroy any quality of life in the extra days gained by it

• e-mail

At first glance, some might think Rolling Stone Ronnie Wood foolish for saying that he would decline chemotherapy, despite his lung cancer diagnosis.

After all, for many, chemotherapy is a lifeline, a way to ensure the cancer cells that might otherwise prove fatal are firmly, albeit brutally, exterminated. And lung cancer is the most common cause of cancer death worldwide.

But I support Ronnie’s view. He joked that he didn’t want chemotherapy because it might ruin his hair — as well it might — but there is the risk of more besides.

For while modern forms of chemotherapy have advanced considerably, the side-effects the treatment may cause can be more than merely unpleasant: chemotherapy can be gruelling and, in some instances, destroy any quality of life in those final extra days gained by it.

Back in action: Ronnie Wood with his twins, Alice and Gracie

Ten years ago, a friend and close colleague, then 50, developed sudden breathlessness after a lifetime of smoking. Concerned, I arranged a chest X-ray and found that one side of her chest was filled with fluid caused by a tumour. The tumour had already spread within the chest, and surgery was not an option.

After two rounds of chemo, she felt so ill — suffering persistent nausea and vomiting unrelieved by medication as well as profound weakness, all continuing long after the treatment was finished — that she chose to withdraw from further treatment.

For her, that was the right decision. It meant she was able to spend her final eight months in the company of those she loved and, for much of that time, though increasingly frail, she was able to live a little.

In a story that almost exactly paralleled hers, another close friend was found to have colon cancer, but withdrew from chemotherapy after only one session. His cancer was not operable, as the tumour had spread to his liver and lungs.

Again, I was supportive of his decision to avoid further treatment because he was unable to tolerate the chemotherapy.

He lived for several more months in relative peace, sustained by palliative care.

If I were diagnosed with advanced, life-threatening cancer, I’d rather stock up on gin and have a jolly good time than have chemotherapy because it might give me a little bit longer.

Of course, this is not to say that chemotherapy is a bad thing. I have many patients who would not be here today without it.

But it matters where you are in your life, the type of cancer you have and the stage it’s reached when it’s diagnosed. As always with medicine, it’s about weighing up the risks and the benefits in your case.

'Some might think Rolling Stone Ronnie Wood foolish for saying that he would decline chemotherapy'

The same applies to cardiopulmonary resuscitation (CPR). Too often, I hear of patients who are plainly at the end of their lives, after a long decline with a terminal illness or a combination of untreatable disorders, being subject to vigorous attempts at resuscitation, which fail, when the right thing to do is accept that nature has taken its course.

I was once called to see a lady who was just over 90 years old, who had died in her chair with a glass of her favourite tincture on the arm. Her family were determined that I should attempt resuscitation, which was quite inappropriate. Eventually, I was able to calm them down.

But the insistence today is that everything must be tried or seen to be tried, and it takes strength, experience and forbearance to say ‘no’.

Ronnie Wood was in a unique position because his tumour was detected as part of a check-up. The implication is that his tumour was diagnosed early and hadn’t spread. He has undergone what appears to be successful surgery.

Although it must have been a shock when he was diagnosed, the fact that cancer hadn’t spread and surgeons agreed to go ahead with surgery alone, without chemotherapy afterwards, suggests the promise of cure.

No case is the same. Most patients deal with the toxicity of chemotherapy; some will want to ‘give it a go’ even if the outlook isn’t promising.

Many of my patients have been determined to fight whatever the cost, and the advances in chemotherapy are such that the side-effects can be controlled, even minimised, while many forms not only improve survival considerably, but can be curative.

The message is: when it come to chemotherapy for cancer, treatment must be individualised and the patient must make their own decisions based on the best information.

We are all different, we all have different priorities and, given what we know, I feel that Ronnie Wood has made the best decision for him.

By the way... My doubts over health system's 'star rating'

There is a quote attributed to the former British Prime Minister Benjamin Disraeli: ‘There are three kinds of lies: lies, damned lies and statistics . . .’

A statistic that will give many readers pause for thought comes from a recent report by the Commonwealth Fund think tank, which declares the NHS is the best, safest and most affordable healthcare system out of a group of 11 countries analysed.

The finding is astonishing to all of us engaged in the provision of care, and probably to many who are on the receiving end, too.

While it is true that, in many areas, the skills, expertise and service within the NHS are beyond compare, when you look closely at the analysis, the think tank seems happy to underplay the fact that for health outcomes — that is, whether people get diagnosed and treated successfully — the NHS ranks near the bottom of the list.

In a study of the qualities of any service, it all comes down to which questions are asked and which are conveniently ignored — depending on the story you hope to tell.

As a comparison, a few years ago, the Government happily rated diesel-fuelled cars as the best on the grounds of superior fuel economy. Now we hear that the pollution from such vehicles is the worst — a fact previously ignored — leading to a turnaround in policy. In the same way, the Commonwealth Fund has focused on the excellence of NHS mechanisms, but is conveniently ignoring its poor results when compared with others.

These experts used declining premature death rates (longer life expectancy) as a sign of success. Yet, as much as anything, this has been the result of public health policy, such as the huge drop in people smoking.

It’s all very well being top dog in terms of affordability — easy when you squeeze the budget — but what about our poor five-year survival figures for some of the most common cancers (breast and colon, for example) when compared with other countries?