Cancer Treatment is a Self-Serving Industry

[ER Eddie]

Here's my own anecdote, to add to the pile.

Six years ago, a colonoscopy showed a benign growth. It was too large to snip, so they recommended surgery. The surgery almost killed me. A leak in the suture caused me to get septic, and it wasn't diagnosed quickly. By the time I got into surgery again, I was in bad shape. It was 50/50 for a while, whether I'd live. I spent 4 weeks in ICU, then 4 in recovery. It was the worst experience of my life, physically. I came out thin, decimated, and with a colostomy. I felt like a freak for a year, until I got it reversed in a third surgery.

Fast forward 5 years, and they are recommending a repeat colonoscopy. Since they "found something" (which was benign, not cancerous) in the first colonoscopy, now the guidelines say I need to get another one. My response: **** off. The recommendations based on your last screening nearly killed me.

I have since read up on colonoscopy outcomes, and I'm not impressed. I'm glad that other people (e.g., dave barnes) have had good results from theirs, and I'm sure plenty of others have as well. Personally, though, I had a horrible experience. I get PTSD-like symptoms when I think of it.

I've lost a lot of faith in the medical system. It wasn't just from that experience, but from other things as well, which I won't go into.

I read that medical errors are the third leading cause of death, behind heart disease and cancer. I was almost one of those statistics, thanks in part to a health screening.

 

[Car-Guy]

Like most of here, I've known more than a few people with cancer. Some died from it, others are still living. Most took some treatment but some did not for various reasons. I suspect age, type of cancer, fear, hope, faith, or whatever affected their decisions. I'll never know if treatments really helped or would have helped for those that opt'd out.

Two men that I knew for decades were both diagnosed with pancreatic cancer. One of was in his late 50's the other in his early 60's. One took chemo, the other elected not to take or do anything. Both live about 9 mos from initial diagnosis. Both were pretty active until the last few weeks of life and both seemed to be "hooked" on pain meds by the time they died. Of course with their prognosis, being hooked on pain meds didn't really matter. Clearly both were in significant and steady pain but at least the pain meds seemed to help a lot.

I'm not sure what I'll do when it (or anything terminal) happens to me, but I can only hope I'll face it with the courage they had.

 

[Midpack]

The anecdotal examples are beside the point, there are thousands of examples of beneficial cancer treatment and thousands of examples of unnecessary even harmful treatment. The data and statistics are all in the article. Basing your decisions on a handful of people you know is less reliable than looking at the broad picture - though many people will continue to do so for all time on every subject imaginable.

No one is saying treat everyone, nor is anyone saying treat no one. The article summarized their recommendations, that’s the place to start discussion. What should we do, what’s best for each of us, based on the overall data?

So what’s the solution to all these problems? Some health-care experts espouse “conservative medicine” as a way to reduce health-care costs and improve outcomes. In “The Case for Being a Medical Conservative," a manifesto published last year, four physicians (including the aforementioned Vinay Prasad) urge colleagues to recognize the human body’s “inherent healing properties and to acknowledge “how little effect the clinician has on outcomes.” Physicians will thus protect themselves “against our greatest foe—hubris.”

Medical conservatives happily adopt new therapies “when the benefit is clear and the evidence strong and unbiased,” the authors emphasize, but many alleged advances “offer, at best, marginal benefits.” Conservative cancer medicine, as I envision it, would engage in less testing, treatment, fear-mongering, military-style rhetoric and hype. It would recognize the limits of medicine, and it would honor the Hippocratic oath: First, do no harm.

Physicians cannot bring about a shift toward conservative cancer medicine on their own. We consumers must help them. We must recognize the limits of medicine and the healing capacities of our bodies. We must resist tests and treatments that have marginal benefits, at best. We may never cure cancer, which stems from the collision of our complex biology with entropy, the tendency of all systems toward disorder. But if we can curtail our fear and greed, our cancer care will surely improve.

 

[audreyh1]

I have found this thread extremely informative particularly because of the anecdotes, and also NW-Bound's several posts of survival rates for various common cancers in various stages.

DH and I each had a parent diagnosed with Stage 4 cancer and die while we were married so we know exactly how that last year to year and a half can play out.

 

[Midpack]

I have found this thread extremely informative particularly because of the anecdotes, and also NW-Bound's several posts of survival rates for various common cancers in various stages.

DH and I each had a parent diagnosed with Stage 4 cancer and die while we were married so we know exactly how that last year to year and a half can play out.

Fair enough. Learning and gathering information from anecdotes can be helpful, as long as you also cast your net much wider for more information and more importantly for making your personal decisions. That’s what I was getting at, clumsily.

 

[Just_Steve]

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.

+1

 

[Bestwifeever]

I have found this thread extremely informative particularly because of the anecdotes, and also NW-Bound's several posts of survival rates for various common cancers in various stages.

DH and I each had a parent diagnosed with Stage 4 cancer and die while we were married so we know exactly how that last year to year and a half can play out.

Absolutely. And when something happens to us or our loved ones, our stories will become anecdotes, and we hope in the successful column; people here are certainly smart enough to know the difference between anecdotes and statistics.

 

[audreyh1]

Fair enough. Learning and gathering information from anecdotes can be helpful, as long as you also cast your net much wider for more information and more importantly for making your personal decisions. That’s what I was getting at, clumsily.

I had two very bleak prognoses and sad demises in my life experience, so many of the anecdotes here have been quite heartening, as they made me realize that it’s completely situation dependent, so to really make sure I understand the situation if I or a close one is unlucky in the future.

 

[athena53]

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.

I appreciate this- anecdotal, I know, but my DIL's father, a really nice man, who's probably early 60s, is undergoing chemo after having a couple of feet of colon removed because they found cancer at the margin. I hope it works out the same for him.

 

[badatmath]

Pretty sure I would not treat stage 4 cancer. It is not going to change the outcome for a lady I know but she is suffering all along the way from all this "treatment".

 

[ER Eddie]

Here's the bottom line from the research mentioned in the OP:

Conclusions: Among currently available screening tests for diseases where death is a common outcome, reductions in disease-specific mortality are uncommon and reductions in all-cause mortality are very rare or non-existent.

https://www.researchgate.net/public...review_of_meta-analyses_and_randomized_trials

I also found this interesting, from the larger article referenced in the OP:

The earlier we can detect cancerous cells, the more likely it is that treatment will succeed. Right? Wrong. One of the most significant findings of the past decade is that many people have cancerous or pre-cancerous cells that, if left untreated, would never have compromised their health.

I had no idea.

Tests cannot reliably distinguish between harmful and harmless cancers. As a result, widespread testing has led to widespread overdiagnosis, the flagging of non-harmful cancerous cells. Overdiagnosis leads in turn to unnecessary chemotherapy, radiation and surgery.

I'll just add that there is a huge monetary incentive to both screen and over-diagnose, so don't expect the medical system to self-correct on this.

The distinction between specific and all-cause mortality is important, too:

Studies of tests for a specific cancer generally look at mortality attributed to that cancer. Mammograms are thus deemed effective if women who get mammograms die less often from breast cancer than women who do not get mammograms. This method can overstate the benefits of tests, because it omits deaths resulting, directly or indirectly, from the diagnosis. After all, surgery, chemotherapy and radiation can have devastating iatrogenic effects, including heart disease, opportunistic infections, other forms of cancer and suicide.

Therefore some studies measure “all-cause” mortality. 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.

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

 

[NW-Bound]

There are a lot of random things in life. Why many people shake off a flu, while a young healthy 15-year-old died of a flu in less than 8 hours after being admitted to the hospital, as I read in the news yesterday?

Surely, anecdotes are important because they tell us what may be possible, good or bad. Will your case be like that when you yourself get sick? No. You need to read about other anecdotes, then look at the statistics to see what's more likely to happen.

In the case of lung cancer, it's almost 50/50 even when it is detected early, as I mentioned earlier. With pancreatic cancer, even when detected early your chance is only 1/3 to make it to 5 years. Now, do you seek treatment or not?

With any cancer, when it gets to stage 4, it is not possible to cure. If you read the 4 books that I referenced in an earlier post, you will know why. Spending a few $100K for a month of misery is not worthwhile, either from the standpoint of financial costs or from the viewpoint of quality of life.

However, even with some stage 4 cancers, some patients are able to have a few more years of life, and the side effect of the exotic chemo drugs is not too bad for them as that varies from patient to patient. Do we pay for that or not? The choice is not as easy as it seems.

 

[LRDave]

The will to survive is tricky, and while it operates at the base of our brain, it sometimes convinces the outer lobes to comply - despite the statistics and the logic.

 

[Katsmeow]

I’ve personally known 3 women with breast cancer. All were “successfully” treated, and it seemed to extend their lives, but all three died of breast cancer within 10 years from initial diagnosis. Maybe you know long term breast cancer survivors? OP link stats below suggest what the odds may be.

I do know long term breast cancer survivors. But, regardless, 10 years is a long time. If I had cancer and could be treated and could live several more years (not being miserable the entire time) then that is a meaningful trade off.

Pretty sure I would not treat stage 4 cancer. It is not going to change the outcome for a lady I know but she is suffering all along the way from all this "treatment".

Again, it depends. I would want to to have a sense of how bad the treatment was and whether there was any real chance of extending life a significant amount (years, not months). I couldn't say without knowing more about the specific cancer, specific treatment, etc. I would know that a cure was not possible but extended life might be worthwhile depending on the details.

Here's the bottom line from the research mentioned in the OP:

Whether screening tests result in reduced mortality is not the same question as asking if cancer treatment works. It is entirely possible that some cancers are treatable even if found without screening tests and that the screening tests don't add a lot of benefit overall but that treatment is nonetheless effective for many.

 

[Amethyst]

I hope I never have to find out exactly how does a physician convey, to a patient who's, say, 85 years old, that treatment will make them supremely miserable; may not (probably won't) work; and thus the patient would do well to give up and go into hospice.

 

[molly312]

Suggestion for all interested in this topic - Read The Emperor of all Maladies by Siddhartha Mukherjee. If you don't want to read such an in-depth book, check out PBS Ken Burns Presents - Cancer the Emperor of all Maladies. My local library has the 3 DVD set and yours likely does also. Nobody knows for sure what they will/won't do regarding treatment until they walk in those shoes. Chemo is nasty but the payoff can be huge. The same is true for radiation and surgery. There is a point when a person just doesn't want the fight anymore. Tremendous research is being done now in the field of CRISPRs. I did not enjoy any of the above but I thank God for the extra time I have had. I can't tell you what my decision will be if and when I have to face the ugly challenge again. However, the more informed you are, the better you will be able to meet the challenges. Please read this book or watch the DVDs.

 

[swakyaby]

I hope I never have to find out exactly how does a physician convey, to a patient who's, say, 85 years old, that treatment will make them supremely miserable; may not (probably won't) work; and thus the patient would do well to give up and go into hospice.

Sadly, I was present at such a conversation. My father with stage 3 colon cancer had undergone 8 months of miserable chemotherapy and stopped one month early because of the side effects. The PET scans appeared clear. But only 6 months later, the cancer was back and now involved the lungs. When my father asked, “what are my options?” The oncologist suggested oral chemotherapy, saying it would be better tolerated than IV chemotherapy. When he asked “What are my chances for cure? 10%? 15%?” The oncologist answered, “Oh no, this is palliative only. There is no possibility of cure at this stage.” I saw the light of life and hope vanish from my father’s eyes. My father, mother, brother and I drove home in silence that day.

 

[ugeauxgirl]

I hope I never have to find out exactly how does a physician convey, to a patient who's, say, 85 years old, that treatment will make them supremely miserable; may not (probably won't) work; and thus the patient would do well to give up and go into hospice.

My husband just sat through this conversation with his dad (84). FIL had colon cancer and the surgeon successfully removed the diseased portion and reattached it. The lymph nodes came back positive for cancer. The oncologist gave my FIL his options which included chemo and radiation. FIL asked about how much these would improve his chances and whether the Dr would do it in his situation. The doc admitted he wouldn't. FIL decided not to go through chemo.

 

[Teacher Terry]

The problem is we all want to be the rare person like my friend. She thought it was worth it to fight stage 4 cancer 8 times over 20 years. My mom was 89 and after chemo failed they tried to convince her to take radiation 5 days a week for the last month of her life. Thankfully she didn’t do it.

 

[Car-Guy]

I have found this thread extremely informative particularly because of the anecdotes, and also NW-Bound's several posts of survival rates for various common cancers in various stages.

DH and I each had a parent diagnosed with Stage 4 cancer and die while we were married so we know exactly how that last year to year and a half can play out.

Absolutely. And when something happens to us or our loved ones, our stories will become anecdotes, and we hope in the successful column; people here are certainly smart enough to know the difference between anecdotes and statistics.

Sometimes the obvious still needs to be said...... +1

 

[NW-Bound]

... Therefore some studies measure “all-cause” mortality. 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.

I need to read the article to understand it better.

It says "Tests for cancer for asymptomatic patients". The article mentions mammograms. Would that also include colonoscopy screening? Pap smear for women?

If your chance of surviving a cancer is the same if you wait until you get some symptoms, then we need to know what these symptoms are, that we should wait for.

In the case of breast cancer, does that mean to wait until the patient feels large lumps in her breasts? In the case of colon cancer, to wait until you pass blood, or feel blockage when going to the toilet (some colon tumors grow large without bleeding)? In the case of cervical cancer, when there's vagina bleeding?

Usually, when there are obvious symptoms as the above, the cancer has progressed to later stages. That's my understanding. And statistics show that later stages of any cancer have lower survival rates.

I don't understand. Perhaps there are symptoms one can look for without any test, and is still in very early stage of the cancer. We need to know what these are.

 

[ratface]

I respectfully disagree with many "blanket" comments here

Let me preface my comments by stating that I find the members of this site to be among the very brightest and well informed on many different subjects. I however find many of your views lacking by a group that typically is spot on. I personally take issue with anyone who flat out stated that any stage 4 cancer is a certain death sentence. It shows a clear misunderstanding of the standard cancer staging system which incorporates size of a tumor, location of a tumor, and spread of a tumor, all of which combined or alone can delineate staging. Sometimes a cancer has an unknown primary which in itself can cause a stage 4 classification. Then there is the chemical analysis of a tissue sample which can determine treatment options based on what caused the cancer in the first place. Some have more favorable treatment options and better survival rates than others, for instance, I'll speak to head and neck cancer, specifically base of the tongue cancer, which was my affliction. In this type of cancer caused by the HPV virus, specifically #16 and #18 have much better survival rates than the traditional drinking and smoking causative factors. Now consider that almost all cervical cancers are HPV related. Cancers are very individualized and treatments are tailored to that individual, by age, weight, and any other health variables of the individual. Chemotherapy and radiation is also tailored using all those variables and closely monitored and adjusted, some are given infused every 30 days in powerful brink of death doses and others are given daily in small tolerable doses to weaker individuals. Treatment options are constantly evolving to the point that head and neck cancer of HPV origin has gone from surgery, radiation, and chemotherapy to just one modality now yielding the same outcome. There is progress, I can speak to only a few minute strides, for instance radiation has come a long way from Cobalt, to Intensity modulated beam, and now proton, each successive one doing less and less damage to nearby tissue. These little improvements exist in every type of cancer treatment and are evolving in imperceptible increments to which the posted article does not reference probably because you really have to experience this stuff first hand to appreciate the little nuances of the horrors of cancer treatment which have allowed this stage 4 survivor to celebrate 10 years of life post diagnosis. To anyone diagnosed with cancer, it's an individual disease with a multitude of variables and blanket conclusions sometimes don't apply.

 

[Turbo29]

Just as a gambler rarely hits the jackpot in Vegas, a patient who undergoes cancer screening is rarely the lucky one whose life is extended from the test, and much more likely to figuratively lose his or her shirt. Common harms of screening include false positive results, risks associated with subsequent diagnostic procedures, and possible unnecessary treatment (and associated side effects) for "cancer" that looks dangerous under the microscope but is actually destined to never cause health problems.

Common Sense Family Doctor: Every screening test is a calculated gamble

 

[NW-Bound]

Common Sense Family Doctor: Every screening test is a calculated gamble

It is now commonly known that PSA test is not a good diagnosis for prostate cancer, and prostate biopsy brings other serious risks.

But other cancer biopsies such as for colon cancer (polyp extraction during a colonoscopy), skin melanoma, breast tumor, pap smear, do not have such risks. Why is it a gamble?

 

[NgineER]

My wife was diagnosed with invasive breast cancer around thanksgiving last year. We scoured the latest medical literature (Up to date articles) and after two second opinions and discussions with the surgeon decided that we should go ahead with a double mastectomy (took place a month ago). She definitely benefited from being able to feel the cancer, which is not common for many other cancers other places in your body.

We met with the oncologist for the second time today. He has us convinced that my wife would not benefit from chemo. Her disease free survival rate is 75% at ten years without doing anything. She has been recommended endocrine treatment which will start soon. This will bring the 10 year disease free survival rate up to 95%, so we have great hopes for her survival.
Part of the reason for the higher disease free survival rate is due to the cancer being node negative and strongly er and pr positive.

She is finally feeling better and has energy again to do things she enjoys.