Dear Sigmund Freud,
In the quiet of your contemplation, I understand the weight of uncertainty that lies heavily upon your soul as you await the recommendations of the Multidisciplinary Tumor Board regarding the treatment of squamous cell carcinoma. It is in these moments, where the veils of mortality and eternity become thin, that the profoundest of questions often sear our hearts.
I, Blaise Pascal, am not a physician of the body, but rather, a student of the human condition and a philosopher of our existential wagers. As you stand at the crossroads of decision and consequence, I would counsel you by means of an analogy drawn from my own meditations—what has become known as Pascal’s Wager. Allow me to apply its essence to the predicament at hand, with the hope that it may provide some solace or guidance.
Consider, for a moment, the following decision matrix as applied to your current situation:
| Treatment Successful (T) | Treatment Unsuccessful (¬T) | |
|---|---|---|
| Pursue Treatment (P) | +∞ (infinite gain) | −c (finite loss) |
| Decline Treatment (¬P) | −∞ (infinite loss) | +c (finite gain) |
In the realm of your health, one might propose that pursuing treatment (P) corresponds to the belief in God in my original wager, and declining treatment (¬P) to disbelief. If the treatment is successful (T), the gain is immeasurable—extended life, the chance for further contributions to the understanding of the human psyche, enjoyment of love and beauty. This we might analogize to the infinite happiness of eternal life in the presence of the Divine.
Should the treatment prove unsuccessful (¬T), there is a loss, but it is a finite one. Whatever discomfort or side effects may ensue, they are bounded by the temporal nature of our existence. Thus, the wager favors the pursuit of treatment, as the possibility of the infinite gain outweighs the finite risk.
Some, however, may not find it within themselves to commit to treatment for various reasons, just as some find it impossible to commit to belief in God. To them, I would say, endeavour to convince yourself of the merits of the treatment, not by disregarding doubt but by interrogating it, by seeking counsel from your physicians, by weighing the outcomes not just in terms of physical health but the full spectrum of your well-being.
The decision matrix is stark, but the human heart is not so easily captured by simple binaries. Emotions, relationships, values, and aspirations—all of these color our decisions. What is paramount, Sigmund, is the thorough examination of the potential gains and losses, both quantifiable and ineffable, before reaching a conclusion. You must also consider the probability of each outcome, as my wager assumes a positive probability that God exists; you must assess the likelihood that the treatment will be successful, which will be informed by the expertise of your physicians.
I urge you, as you await the board’s recommendations, to prepare your mind and heart. Reflect upon what you hold most dear and what risks you are willing to accept. Consult with those you trust, both in the medical profession and within your personal enclave, and do not eschew the emotional and psychological aspects of your decision.
In closing, Sigmund, remember that while philosophers and theologians like myself can offer frameworks and analogies, the decision is intimately your own. It must resonate with your innermost convictions and the truths you have unearthed in the depths of the psyche.
May you find clarity and peace in whatever course you choose, and may your decision, like the very wager I have proposed, be made with the fullness of hope and the courage of conviction.
With empathetic thought,
Blaise PASCAL
(1623–1662)
Seventeenth-century French mathematician, philosopher, physicist, and theologian
2024-01-26 20:49 Telekonsultation
To: Oncology Department
Subject: Treatment Recommendations for Squamous Cell Carcinoma of the Head and Neck (SCCHN)
Multidisciplinary Tumor Board (MTB) Review
Case: Squamous Cell Carcinoma of the Head and Neck
The Vienna Multidisciplinary Tumor Board (MTB) has convened to review the case and provide consensus recommendations for the treatment of the patient with squamous cell carcinoma of the head and neck (SCCHN). The following points were discussed in detail:
- Surgical Treatment and Reconstruction: It was agreed that for cases primarily treated with surgery, meticulous attention must be given to establishing clear resection margins. Surgical techniques should be tailored to the extent of the disease, and the possibility of reconstruction is considered depending on the defect following resection. In cases involving the skull base, such as nasal and paranasal sinus cancers, collaboration with neurosurgeons and ophthalmologists is critical.
- Radiation Therapy: Radiation oncologists presented their protocols on dose, fraction, field, and setting (palliative or definitive) for cases better suited to radiation. The board also discussed the potential for stereotactic radiosurgery for metastatic lung lesions and the conditions under which re-irradiation might be warranted.
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Multimodal Treatment: The board reviewed new cases that require combination therapy, including surgery, radiation, and chemotherapy. These multimodal approaches aim to optimize outcomes and are individualized based on tumor characteristics and patient factors.
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Challenging Cases: Cases with complications or suboptimal responses during or after treatment were reviewed for additional or alternative interventions. The board emphasized the importance of close monitoring and flexibility in treatment plans.
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Treatment Decisions in Laryngeal and Pharyngeal Cancers: Discussions centered on whether to proceed with upfront surgery or non-surgical treatments such as chemoradiation in patients with resectable laryngeal and pharyngeal cancers. The decision is influenced by the desire to preserve laryngeal function without compromising oncologic outcomes.
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Induction Chemotherapy Prior to Chemoradiotherapy (CRT): The board evaluated the indications for induction chemotherapy before CRT, underscoring its potential in improving survival, achieving distant control, and preserving the larynx.
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Neoadjuvant Chemotherapy Before Oral Cancer Surgery: The MTB addressed the indication for neoadjuvant chemotherapy before surgery in oral cancers, aiming to reduce tumor burden and improve surgical outcomes.
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Definitive Radiotherapy or CRT in Laryngeal Cancer: For high-risk stage II laryngeal cancer, the board deliberated on the benefits of definitive radiotherapy alone versus combined CRT, considering factors such as tumor size and patient comorbidities.
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Adjuvant CRT Post-Operatively: In cases of postoperative high-risk SCCHN, the board compared the advantages of adjuvant CRT versus radiotherapy alone, emphasizing the importance of assessing both the tumor pathology and patient health status.
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Pharmacotherapy for Recurrent and Metastatic Disease: Current pharmacotherapeutic options for recurrent and metastatic SCCHN were reviewed, with discussions on the latest targeted therapies and immunotherapies. The pharmacotherapy committee provided updates on drug efficacy, safety, and integration with other treatment modalities.
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Re-Irradiation for Recurrent Disease: The risks and benefits of re-irradiation were assessed for patients with recurrent disease, considering factors such as prior radiation dose, interval since initial treatment, and the patient’s overall condition.
It is the consensus of the MTB that the treatment of SCCHN requires an individualized approach, considering the disease’s location, stage, and patient-specific factors such as performance status and comorbidities. The recommendations provided herein are guided by current evidence and the collective expertise of the MTB members. The board encourages ongoing communication among the multidisciplinary team to ensure the best possible outcomes for our patients.
MTB
Multidisciplinary Tumor Board
(AI generated)
Termin vereinbaren
Ordination Dr. Michael Truppe
Albertgasse 3/6 1080 Wien
Telefon 01 408 95 00 66
Email ordination@smile.wien
Ein verbindlicher Behandlungsplan und Heilkostenplan wird gemäß den Vorgaben der Zahnärztekammer erst nach einer Konsultation in der Praxis erstellt.
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