CURE

「Can I be Cured?」這是癌症病人最常提出的問題。

在中文語境中,它會以不同形式出現:「有得醫嗎?」「可以治癒嗎?」「醫生,我會很快死嗎?」患者都希望醫生即時給予決斷性答案。

早前受邀至里斯本著名的Champalimaud Clinical Centre發表主題演講,題目極具挑戰性:「治癒肺癌:現況與未來」(Cure of Lung Cancer : Present and Future),當然不可能把四十分鐘的演說濃縮成五百字,只談:「Cure」為何物。

根據字源學,Cure源自拉丁文Cura,意指「關懷」(Care),直至中世紀英語才採納Cure這詞,當年意思是「恢復健康」(Restore health to normal state),但要知道中世紀人類並未知道癌症為何物,所謂「Cancer Cure」(癌症治癒)的現代概念,是後來醫學發展的產物。

在病人眼中,Cure往往被簡化為:治療後所有的掃描與驗血都找不到腫瘤。然而,這是最普遍、也最易被誤解的定義。任何一位腫瘤科醫生都清楚知道,現今科技尚無法偵測肉眼看不見的微量癌細胞,掃描結果「一切正常」並不等同於治癒,因為這定義缺乏了「時間性」。若要包括時間維度,便惟有靠統計學,一般會採用Kaplan-Meier Survival Curve(存活曲綫)來估算復發機率。當曲綫在多年後開始平走時,復發風險降至極低,醫學上才勉強被定義為Cure或Statistical Cure。

故此,最本事的醫生也不能給予百份百的保證,只能說統計學上很大機會不復發,既無絕對,也不必強求絕對,只求最高水平的治療及最大程度的關懷,便能得到最高機會。

反正,Cure本身就是關懷!

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