Cancer care: Too much and too little

Cancer care: Too much and too littleThere were two disturbing reports from the American Society of Clinical Oncology that seemed to suggest opposite problems.From MedPage Today:

Many patients with early-stage non-small-cell lung cancer (NSCLC) never see a medical oncologist because their primary care physicians don't think chemotherapy can help them.

And from Modern Healthcare:

Cancer care for patients who are near death is becoming more aggressive, with doctors ordering chemotherapy and other medicines in often futile attempts to extend lives, according to a study by Harvard Medical School researchers. Doctors should review their treatment regimens and in some cases focus on palliative care for patients in the last days of their lives instead of on costly medicine, the researchers said.

Both problems are serious and --based on my experience-- real. I think they may also be related. A relative of mine was initially denied chemotherapy for leukemia --because the doctors thought he was too old. Turns out that age wasn't really a legitimate factor, based on the evidence, and when we fought for chemo he responded well and lived another 10 months with a reasonable quality of life. At the end, we opted for palliative care and he didn't go through a useless and painful regimen.But patients and families can be forgiven for pushing for aggressive care --even that which the researchers deem "futile." Not everybody wants to go down without a fight, and patients may have it in the back of their minds that their doctors are performing a cost/benefit analysis on them and deciding it's not worth the effort for a small chance of recovery or that the doctors may not really know what works. By the time a patient works his way through the system and finds an oncologist who will treat him, it may also be too late for the standard protocols.Finally, with all the new cancer drugs in development there's going to be even more aggressive late-stage treatment, much of it futile.