You pride yourself on how thorough you delve into every aspect of your client’s financial lives.  Your inquiry includes questions about a living will, estate planning, insurance, long-term care and other end-of-life issues.

John McCain’s battle with glioblastoma may cause you to reflect on your process.

Do you elicit the views of your clients on when to discontinue treatment or whether to initiate it at all, when confronted with a serious diagnosis?

Glioblastoma is Illustrative of the problem

Glioblastoma is a vicious form of brain tumor.

It’s notoriously difficult to treat.  Skilled surgeons can remove as much of the tumor as possible, and treat the patient aggressively with concurrent radiation and oral chemotherapy.

Glioblastoma is impossible to cure.

The treatment options carry the risk of onerous side effects.  Experts admit they still don’t know enough about glioblastoma to know how many drugs to use and what kind of drugs and how much radiation to use.

The average survival rate is between 1.5 and two years.  Senator McCain, who received world-class treatment, survived 13 months after his diagnosis was publicly announced.

Without treatment, people with glioblastoma typically die within three months.

If you are interested in more information about survival rates for those diagnosed with this terrible disease, this study is helpful.

Quality of life

The list of side effects of the standard treatment for glioblastoma is daunting.  You can find common side effects of oral chemotherapy drugs here.  You can find side effects of radiotherapy here.

Risk/benefit analysis

As an advisor, you’re comfortable with data.  Here are some statistics for glioblastoma:

• Younger patients are more likely to survive longer;
• Depending on symptoms, combining surgery with radiotherapy or temozolomide chemotherapy increased the survival rate to 1-2 years.
• Other studies showed the combination of radiation and the drug Temodar increased the survival rate up to 4 times more than using radiation alone.

There’s similar data available for other forms of cancer.

One study found that most people with certain types of stage 4 cancer (not glioblastoma) didn’t understand that chemotherapy was not likely to be a cure. Those patients didn’t have the knowledge to ask this basic question:  Given my age and the stage of my cancer, how much longer am I likely to live if I proceed (or continue) with this treatment?

The response could be, as little as a couple of weeks or months.

The risk/benefit analysis of undergoing treatment versus palliative care is a very personal and individualized one.

If you want to add real value, initiate a thoughtful discussion about it early in your relationship.  I’m not suggesting you weigh in on the merits.  Your role is simply to raise the issue and encourage your clients to communicate about it.

Resource of the week

This article discusses when cancer treatment should be discontinued.