Almost 40 years after President Nixon signed the National Cancer Act into law, here’s a paper about lung cancer treatment in Journal of Oncology Practice that ought to give one pause.
Lung cancer is a terrible disease, no doubt about that. In the United States in 2009, 219,000 people were diagnosed with lung cancer, and 159,390 people died from it. The five-year survival rate for patients diagnosed with lung cancer (all stages) is 15%; for patients with Stage IV lung cancer, it is a paltry 2%.
The purpose of the JOP study was to evaluate the effectiveness of the Level I Pathway in treating patients with Stage III or Stage IV non-small-cell lung cancer. The Level I Pathway is an evidence-based protocol developed and continually updated by Innovent Oncology, the research arm of US Oncology, the nation’s largest cancer treatment network.
The study followed all patients diagnosed with non-small-cell lung cancer beginning chemotherapy at eight US Oncology treatment centers between 1 July 2006 and 31 December 2007. A total of 1,409 patients were included in the study; more than half of them died before the 12-month follow-up period was completed. 1,095 of the patients were treated according to the protocols of the Level I Pathway, and 314 of them were treated off-pathway.
The average twelve-month cost for patients treated on-pathway was $18,042, while for those treated off-pathway it was $27,737 – more than one-and-a-half times as much. And yet there was no difference in survival rates between the two groups.
In plain English, it looks like there are a lot of docs out there who are throwing everything but the kitchen sink at these patients, to no good effect other than to fatten their own investment portfolios – not to mention those of the guys who own the drug companies and the manufacturers of medical devices.
Moreover, given that the survival rates for patients with advanced lung cancer are so dismal, whether Level I Protocols or the everything-but-the-kitchen-sink approach is employed, I can’t help wondering how much better Level I Protocols themselves are than giving patients palliative care only.
It’s time to re-think our strategy in the War On Cancer. At the very least, we ought to stop acting as if “rationing” is a dirty word. We already ration medical care, and we will continue to do so, under any conceivable set of incentives, because our desires are unlimited and our ability to satisfy them are not.
We also ought to stop treating as axiomatic calls for “new medicines.” We aren’t even paying for the medicines we have now. And, as this paper makes clear, often the doctors themselves don’t which of the interventions they foist on their patients are doing them any good.
We know how to end lung cancer. If people would stop smoking, that would eliminate most new cases right there, and we could eliminate most of the rest by testing homes for radon and making sure the ones which have high levels of that gas are adequately ventilated.
Given that lung cancer is virtually 100% preventable, and given that efforts to date to find a cure have yielded such meager results, can we really justify continuing to pour billions of research dollars down that particular hole? Not to mention torturing untold numbers of laboratory animals each year. After all, smokers have a choice – the lab animals don’t.
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Richard Rider
Willett .
Lucinda Bliss
LEV JANASHVILI
TimingLogic
Patrick Frank
Salon.com
Comments
I advocate better smoking cessation funding (for such things as telephone quit lines and subsidized tobacco cessation drugs) as well as more treatment research. This is an area ripe for palliative care research, yet for some reason, it's difficult to get people to care. Yet for some reason, everybody thinks they should wear pink to tell the world how much they care about breast cancer, which is not a top killer of women. (Heart disease is first, then lung cancer.)
Full disclosure: I wrote my dissertation on symptom distress in lung cancer. M father began smoking in the military, as many young men did, and died of lung cancer at age 79. So I'm coming at this from both an informed and an emotional perspective.
First, I am sorry for your losses. Death is life's bitterest fact, no doubt about that.
My father died from his addiction to tobacco (complications due to emphysema, not cancer). The irony is, he had quit smoking more than twenty years before that, but once emphysema gets its claws into you, it won't let go. I can tell you I would rather have had a father who didn't smoke at all.
After almost forty years of a War On Cancer, it's reasonable to ask how much bang we're getting for our buck. Here's an article in the New York Times by respected science writer Gina Kolata which says that despite the media's focus on five-year survival rates, and on the few kinds of cancer medicine really can cure (e.g., testicular cancer. chronic myelogenous leukemia, and a few others) death rates for most kinds of cancer have not changed much.
http://www.nytimes.com/2009/04/24/health/policy/24cancer.html?ref=forty_years_war
I was trained as a scientist and most of my life I took as given the acquisition of scientific knowledge was an unalloyed good. But maybe it's time to put more focus on applying the knowledge we already have. C.S. Lewis (writing in 1940) said that the consistent practice of virtue by ten percent of the human race for ten years would fill the earth from pole to pole with peace, plenty, health, merriment, and heart's ease. I cannot prove that he was right, but it's something to think about.
Thanks to all of you for your thoughtful comments.
http://www.amazon.com/Problem-Pain-CD-C-Lewis/dp/0060757485/ref=sr_1_1?ie=UTF8&s=books&qid=1288255306&sr=1-1
Again, thanks to everyone for reading and commenting.
Well done and persuasive
Lew