Cancer Treatment is a Self-Serving Industry

[mystang52]

Sorry you’re tired of hearing about PSA, but I never imagined and expected anyone would bother reading about it unless confronted with a high result personally or a friend/family member.

My point is that high PSA, in and of itself, does not lead to treatment AFAIK. "Treatment" being defined as surgery, or the various types of radiation. Biopsy is often the next step after high PSA, or jump in PSA. But that's diagnostic.

 

[SecondCor521]

I understand the OP was posting about cancer, but on a related note:

My Mom chose to go on hospice care about 12 months before she passed away from IPF, a progressive, fatal lung disease. It was a very good decision for her and for the rest of the family, because it did enable her to live her last year without fighting to live. She was able to stop some of her maintenance medicines (why bother trying to keep your cholesterol in check in that situation?), and was able to focus on enjoying her remaining time. It also helped her and those who loved her to begin to accept her death such that her actual passing was not very traumatic.

On a financial level - which is waaay down the list of priorities in these scenarios - it was also a good decision. Hospice care was very well covered by her insurance, and she was able to receive her care entirely or nearly entirely in her own home. The actual medical care in her case was mostly just oxygen and morphine. They also had counselors who were very helpful to her, my Dad, and her children.

 

[NW-Bound]

Tek, the problem is you don’t know who will be the lucky survivor...

Oncologists usually know the risks. For Stage 4 cancers, they can tell you that your chance is slim such as 1 in a 100, or the best you can hope for is to linger a few more months in misery due to the drug effects. How do they know? It's because many patients before you have gone through the ordeal, and nobody makes it.

However, patients often hope that their body is different, or that a new drug or combination of drugs will work this time. And the tough part is that if nobody tries new drugs or new approaches, we will not discover new therapies. Hope springs eternal.


Here are four books on cancer that I have read and recommended here on this forum:

1) The Emperor of All Maladies: A Biography of Cancer, Siddhartha Mukherjee (2011)

2) The Cancer Chronicles: Unlocking Medicine's Deepest Mystery, George Johnson (2013)

3) Anticancer: A New Way Of Life, David Servan-Schreiber (2007)

4) The Last Lecture, Randy Pausch (2008)

The last 2 books were written by cancer patients.


About people's strong will to live and the denying of reality, I recall an incidence told in the 1st book above. An elderly cancer patient was on her last leg, and her oncologist said nothing could be done to save her. The patient's daughter was upset, and said she could not believe modern medicine would run out of options. The daughter was a medical doctor.

 

[davebarnes]

As someone who had a colonoscopy at age 65.05 courtesy of Medicare and Kaiser.
As someone who was told "you've got cancer".
As someone who underwent surgery (trivial 14 cm removal) and 6 months of chemo (ugly).
As someone who is colon cancer free after 6+ years.

I say: educate yourself and make the best decision for you.
Remember—you are the customer and not the patient.

 

[robnplunder]

My personal data (about a dozen cases) show that people don't survive cancer. Only one person I know survived and it was very treatable prostate cancer that was caught early. All others perished, some lasting longer than the stat and others dying quickly. All suffered terribly at the hands of modern medical remedies. One actually died during a chemo session.

I am telling myself that I would accept fate and forgo the treatments. But can I actually follow through it? I am not so sure. It is hard to go against our instinct to survive.

 

[davebarnes]

One actually died during a chemo session.

When I did chemo I was always the youngest person in the room.
I did not see anyone die, but many looked like death warmed over.
The typical chemo dosage is: just under the 'will kill you' threshold.

 

[NW-Bound]

A lot depends on the cancer type, and the stage it has progressed to.

For example, take colon cancer.

In the early stages, colon cancer is one of the most curable cancers. In the later stages, it is the second most deadly. Colon cancer is the second leading cause of death from cancer in America (lung cancer is the first).

The 5-year survival rate of people with localized stage colorectal cancer is 90%. About 39% of patients are diagnosed at this early stage.

If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 71%.

Usually, if a cancer does not reoccur in 5 years, the patient is considered cured. It is because if the cancer cells are still in the body, they will grow back fast within 5 years. If you make it to the 5-year mark, chances are high that you are a survivor.

Now, look at lung cancer.

The five-year survival rate for lung cancer is 56 percent for cases detected when the disease is still localized (within the lungs). However, only 16 percent of lung cancer cases are diagnosed at an early stage.

For distant tumors (spread to other organs) the five-year survival rate is only 5 percent.

So, if you are diagnosed with colon cancer, do you refuse treatment and accept death, which surely will come?

And thyroid cancer is so benign that they say if you have to have cancer, thyroid cancer should be your choice. Only 2% of patients die.

 

[NW-Bound]

Breast cancer was brought up earlier. Here's the survival rate.

The average 5-year survival rate for women with invasive breast cancer is 91%.

The average 10-year survival rate for women with invasive breast cancer is 84%.

If the cancer is located only in the breast, the 5-year survival rate of women with breast cancer is 99%.

Now, do we treat them, or let them die, which they surely would?

 

[Aerides]

MIL survived Lung Cancer, which spread and regrouped as a brain cancer (not sure which, but was operable/chemo-able). She was in remission for both for well past 5 years before any additional illness appeared.

Most cancers have a decent rate of survival, particularly in their early stages (1-3), and no one here is saying "don't treat any of them then, harrumph!"

It's those Stage-4-Metastasized-Inoperable ones that are far trickier. Doctors can only extend your life, and the question then has to become quality vs. quantity (and none of us can judge anyone for what they pick, nor knows ourselves what the answer might be until/unless we one day face it.)

 

[ncbill]

Tough topic. My first wife had less than 2 years from cancer diagnosis to passing. I often wonder if we could have enjoyed our limited time together better than the hell of chemotherapy, heart damage and pain of sudden loss.

https://blogs.scientificamerican.com/cross-check/the-cancer-industry-hype-vs-reality/



"A 2015 meta-analysis by epidemiologist John Ioannidis (renowned for bringing the scientific replication crisis to light) and others found no reductions in all-cause mortality from tests for cancer of the breast, prostate, colon, lung, cervix, mouth or ovaries for asymptomatic patients."

Reading one of those "how we die" articles years ago it noted most cancer deaths occur while still undergoing relatively aggressive treatment.

In contrast, it also gave the example of a pediatric oncologist who received a terminal cancer diagnosis...one of those "most everyone's dead within a year" cancers.

But the article also noted that doctor had a colleague with a new therapy that had resulted in 5 year survival rates of around 15%.

The affected doctor...closed his practice and went home to spend time with his family.

Unlike the general public, doctors are experienced enough not to grasp at straws.

Going through this now with an older relative (70s) who for whatever reason chose to ignore a ~50 lb weight loss (they were never heavy) before being diagnosed with pancreatic cancer several months later.

Yeah, we're all doing the "rah-rah-rah" around them trying to keep their hopes up...they just had a port installed for some heavy-duty chemo, followed by surgery, followed by I'm sure everything & the kitchen sink...but let's be honest, it almost certainly won't make a difference.

 

[NW-Bound]

Most cancers have a decent rate of survival, particularly in their early stages (1-3), and no one here is saying "don't treat any of them then, harrumph!"

That's the impression that I had when seeing the thread title.

And I just read the article. It talks about ineffective over-screening that often results in false diagnosis of cancer, or over treatments.

The above is not the same as fruitless treatments of terminal cases.

It's those Stage-4-Metastasized-Inoperable ones that are far trickier. Doctors can only extend your life, and the question then has to become quality vs. quantity (and none of us can judge anyone for what they pick, nor knows ourselves what the answer might be until/unless we one day face it.)

Perhaps the patients or their families in these cases would make a different choice if they had to bear the cost. Do I spend $1M to linger on for another month and leave my spouse homeless, or do I leave the money to allow my grandchildren to have a better future? I am willing to bet that the problem will resolve itself.

 

[MichaelB]

Health care economics suffer from an extreme case of asynchronous information, which is one foundation of rational decision making. Medical care providers will always know more than patients about both diagnosis and treatment.

When consumers want to maximize treatment and providers want to maximize revenue, the outcome is, as expected, an escalation in cost that has no upper limit. Providers would be not acting rationally if they didn’t exploit that. As hospital groups become more involved in diagnosis and care, this problem is likely to become worse.

Diagnosis and care is dependent on individual physician’s assessment, and there isn’t a systematic way to challenge either. The incentives built into the system are to diagnose and treat without limit. There is no natural, easy way to stop this from happening. It’s not limited to cancer, either, as heart disease also sufffers from excessive expensive treatment.

It would be interesting to see a comparison of how physicians diagnose and treat other physicians. We know physicians as patients opt for less treatment for terminal illness, but we don’t know how doctors advise physician patients.

 

[Scratchy]

Tough topic. My first wife had less than 2 years from cancer diagnosis to passing. I often wonder if we could have enjoyed our limited time together better than the hell of chemotherapy, heart damage and pain of sudden loss.

I have the special pain of knowing that I convinced her to continue Chemo when she was going through hell.

I don't know if I'd do anything different, but I was young and wish I had learned and challenged more.

Your wife surely took heart in knowing that she could do what she did partly for you. And you don't know what the other road would have been like. You made this choice together out of love for each other so it most certainly was the right choice.

 

[NW-Bound]

I don't know the prognosis of the OP's wife when she underwent treatment. It could be the right thing to do. Even for a cancer with a good prognosis where the survival rate is 98%, one could still be that unfortunate 2%.

I mentioned earlier thyroid cancer as one of the "easy peasy" cancers. I will mention here that I know two persons with that cancer. One sailed right through surgery and radiation, and is doing well with not much change in lifestyle, other than taking some maintenance medicine to make up for the lack of the thyroid which has been removed (thyroidectomy). Hers is a textbook benign thyroid cancer.

The other person died in a matter of a few months. His type is called "anaplastic thyroid cancer", which is rare. This acute type of cancer has a very poor prognosis. It spreads very fast, and the patient's life expectancy is measured in months.

We now have another relative who developed a different type of acute cancer that is quite rare and aggressive. The prognosis is poor, but being young she still wants to pursue treatment, which involves radical surgeries that would make everyone cringe. She is still fighting to survive. It is very sad.

PS. Some forms of cancer are so rare doctors do not have enough case histories and experience to treat them. They are groping in the dark. All they knew is that patients inevitably died. Do they give up and not try again when seeing a new case?

PPS. Even for lung cancer which is common, the survival rate is poor at about 1/2 as mentioned earlier, and even when it is detected early. However, because it is common and affects more than 200,000 people each year, doctors are still trying. Do we give up now?

More than 228,000 people in the US will be diagnosed with lung cancer this year, with a new diagnosis every 2.3 minutes. 60% to 65% of all new lung cancer diagnoses are among people who have never smoked or are former smokers. 10% to 15% of new lung cancer cases are among never-smokers.

 

[SecondCor521]

It would be interesting to see a comparison of how physicians diagnose and treat other physicians. We know physicians as patients opt for less treatment for terminal illness, but we don’t know how doctors advise physician patients.

I have several doctors in my family. I am not a doctor.

From what I've seen, doctors diagnose their patients exactly the same whether their patient is a physician or not.

They will generally be more blunt and more scientific about providing information if the patient is a physician. They will also generally be more deferential regarding treatment decisions, since a physician patient is probably fairly good at deciding how to proceed.

I agree with your statement that most older doctors are far less likely to seek aggressive treatments for themselves. They are more likely to believe the statistics and less likely to think that they will somehow beat the odds. They're also probably better than average at understanding the likelihood of new or untested treatments actually working, as they're familiar with how often (or not) those kinds of things tend to succeed, and they also understand the new treatment development process and can accurately assess what promise a "stage 1 trial" drug might hold, for example.

 

[Amethyst]

When I was trying to eradicate Canada thistle from my garden, using surgery (digging) and chemo (glyphosate), I once quite literally dug up every plant (something with no medical equivalent), dug out every speck of dirt and sifted it for bits of underground stems, then replaced the soil, covered it with plastic and let it sit in the sun for a season (radiation).

The thistles were gone for a while, but then they came back.

Cancer is like that.

The typical chemo dosage is: just under the 'will kill you' threshold.

 

[ls99]

At this stage of my life, it seems I knew more people well, then I know now.

Of the late bunch at least a dozed died of cancer, all had agressive treatments, as result all had a long and miserable existence for a good while, I don't know by whose choice. That bunch beleived: doctor knows best.

Late DW died from cancer a few years ago, she also knew all the above noted crowd and their treatments. She refused both radiation and chemo, I concurred. It was a short exit.

 

[Mulligan]

I know of a few cancer patients who stopped treatments and accepted death. They were in their 70s though.

And I have a cousin who even refused dialysis after diagnosis of renal failure. He said the quality of life would be poor, and he accepted death. His health steadily declined, and he eventually died. He was in his mid 70s.

That was where my dad was at except around 80. About 4 years prior it appeared he beat the cancer through radiation and chemo. When it came back in his liver, he said no thanks to treatment again. I feel good and will enjoy the time I have.
Doc, said about 6 months to live and he got 15 good months with really only the last 3 weeks bad.
He made the wise choice looking back. But ones age matters. 80 realistically is a full life for a man.

 

[NW-Bound]

That was where my dad was at except around 80. About 4 years prior it appeared he beat the cancer through radiation and chemo. When it came back in his liver, he said no thanks to treatment again. I feel good and will enjoy the time I have.
Doc, said about 6 months to live and he got 15 good months with really only the last 3 weeks bad.
He made the wise choice looking back. But ones age matters. 80 realistically is a full life for a man.

At 80 years of age, that's the right choice. The original treatment got him 4 years, and I hope he thought it was worth it.

But when a cancer recurs, it has morphed. It will not respond to the old drug the same way. The treatment will have to be kicked up several notches, with new drugs which will have more hideous effects. Come to think about it, if these drugs were that good, why would they not use them in the first round?

He could have tried the new treatment to see if he could take it. Most likely, he would not be able to handle the rigour, and would have dropped out of the treatment. I knew some old people who did that, to try it and quit. They did not hang on. At some point, one should realize that his time has come, and the battle is already lost.

 

[NW-Bound]

When I was trying to eradicate Canada thistle from my garden, using surgery (digging) and chemo (glyphosate), I once quite literally dug up every plant (something with no medical equivalent), dug out every speck of dirt and sifted it for bits of underground stems, then replaced the soil, covered it with plastic and let it sit in the sun for a season (radiation).

The thistles were gone for a while, but then they came back.

Cancer is like that.

No, not all cancer.

However, while RV'ing, we met a couple whose wife had cancer twice. First, a colon cancer of which she was cured. Then, she had breast cancer. Now, they can look at the cells and know that the 2nd cancer is at the original site, and not metastasized from another organ. Her 2 cancers are separate, and different.

And she beat the 2nd one too. Talk about cheating death twice. Did she ER? You bet she did.

 

[athena53]

But don't blame it all on the doctors. It's the patients who often clamor to have the latest drugs, whether they work or not. Money be damned. How else do you think we have a policy of "no lifetime limits" on medical costs?

It is very hard for sick people to accept that they are going to die, and that nothing can help them. I have posted plenty about books that talk about this.

I agree. Most of us are talking anecdotes but two that stand out for me on this- a woman in her 80s in my church had an autologous bone marrow transplant for non-Hodgkin's lymphoma. Expensive, drastic, small chance of success. She didn't survive. Joyce Maynard's memoir, "The Best of Us"- her beloved husband was diagnosed with pancreatic cancer, probably late 50s/early 60s and she went into Tiger Wife Mode. Chemo. Expensive alternative treatments, the Whipple procedure (a risky surgery with a small chance of success)... and he died.


The decision is different for everyone; my mother, age 85, refused treatment for a recurrence of breast cancer and DH, age 78, chose hospice care for acute myeloid leukemia. All of us agreed with those decisions and they died quietly at home. At 67, in excellent general health, I'd probably choose treatment if it had a decent chance of success.



Some people,however, seem to want to fight it with everything, especially if Medicare is paying the tab. I'd rather see those dollars going towards keeping younger people healthy.

 

[momoftwo]

I'm happy my husbands metastasized tongue cancer wasnt deemed too expensive to treat at age 62.
We're enjoying a pretty fine retirement together 7 years later. No cancer in sight.

 

[swakyaby]

My point is that high PSA, in and of itself, does not lead to treatment AFAIK. "Treatment" being defined as surgery, or the various types of radiation. Biopsy is often the next step after high PSA, or jump in PSA. But that's diagnostic.

+1

PSA blood test, like a mammogram, is a screening test that does not, in itself, provide a diagnosis. An abnormal result in a screening test, however, often leads to a recommendation for a diagnostic test such as a tissue biopsy.

 

[swakyaby]

It would be interesting to see a comparison of how physicians diagnose and treat other physicians. We know physicians as patients opt for less treatment for terminal illness, but we don’t know how doctors advise physician patients.

As far as I’ve observed, physicians with life-threatening malignancies are given the same treatment options as anyone else. The course of treatment is always the patient’s choice.

 

[athena53]

As far as I’ve observed, physicians with life-threatening malignancies are given the same treatment options as anyone else. The course of treatment is always the patient’s choice.

I agree, but according to an episode of a podcast called "Sound Medicine" (discontinued- I miss it), more doctors tend to choose palliative acre when aggressive treatment has a 100% chance of making them miserable and only a small chance of success.