Quest for a Peaceful Death

When a cancer patient has run out of options — when her disease has returned and the latest experimental drug has failed and her oncologist hasn’t much to say — that’s when the patient would be fortunate to meet Tracy Balboni. She’s a radiation oncologist and palliative care researcher at Harvard Medical School and Dana-Farber Cancer Institute in Boston. She works at the murky stage of care known as end-of-life, where decisions about additional treatment can be complicated by fear and pain.

Simply put, Balboni’s job is to relieve the pain and provide the highest quality of life possible. Her more conventional tool is radiotherapy. Normally radiation oncologists attack tumors with as much force as the patient can stand, in an effort to eliminate the disease. Palliative radiation oncologists like Balboni, treating advanced cases, use doses of radiation that are extremely quick. They may, for example, try to reduce a spinal tumor lest a person become paralyzed, or shrink malignant obstructions in the abdomen. “You’re using the technology to help patients live better,” Balboni says. “Today we have patients living much longer with their cancers. Instead of two months it might be 10 years. Yes, we need to cure, but in the setting where we can’t cure, we need to use these tools in a way so that patients can live well as long as possible.”