I'm not posting this just to make the day gloomier, only to help us all be well-informed. Misconceptions prevail because they make us feel better but a relective person feels stronger when better-informed.
This brief message from Dr. Gawande should get more attention.
Take a moment to read the comments/ replies.
70+% of terminal cancer pts believe, wrongly, that they're on chemo to cure them. Who is to blame? Via @incidentalecon goo.gl/fb/BVonY — Atul Gawande (@Atul_Gawande) October 25, 2012
This feels like the flip side of yesterday’s post, where big effects were often found to be outliers. In this study, patients were asked about their expectations for chemotherapy for metastatic lung or colorectal cancer. The bad news is that these cancers have terrible prognoses. Chemotherapy is still the treatment of choice, but the effect we’re hoping for is an extension of life by weeks to months. Maybe you’ll see some relief of symptoms. But it’s not going to be curative. There are also, of course, significant side effects.
This NEJM report spells out some hard truths.
Chemotherapy for metastatic lung or colorectal cancer can prolong life by weeks or months and may provide palliation, but it is not curative.
[...]
Overall, 69% of patients with lung cancer and 81% of those with colorectal cancer did not report understanding that chemotherapy was not at all likely to cure their cancer.
[...]
Many patients receiving chemotherapy for incurable cancers may not understand that chemotherapy is unlikely to be curative, which could compromise their ability to make informed treatment decisions that are consonant with their preferences. Physicians may be able to improve patients' understanding, but this may come at the cost of patients' satisfaction with them.
Dr. Atul Gawande wrote an article in the New Yorker some time back on the lengths to which cancer patients would go based on their misunderstanding of curative and palliative power of cancer treatments. Those who understood the difference lived the remainder of their lives more peacefully and sometimes even longer than those who in their panic, subjected themselves repeatedly to ever newer and more toxic chemo drugs and radiation doses. It is sad of course but many cancer patients are relatively young and it is hard for them to come to terms with their mortality. A daughter-in-law of a very good friend of mine is currently in the midst of battling cancer. She is done with her harrowing chemo regimen. The mental toll it has taken on the woman (in her mid forties) is almost as severe as her physical ordeal.
Posted by: Ruchira | October 25, 2012 at 11:35 PM
Instead of chemotherapy better to make use of natural remedies, because it cures the diseases without any side effects.
Posted by: Is There a Cure for Cancer | October 26, 2012 at 03:42 AM
Thanks for your comment, Ruchira. (The comment above, incidentally, would be considered spam in any other place, but in this case I think it's okay to leave it in place. I spot checked a couple of the links and as far as I can tell they aren't selling anything, and the information appeared to be very general, and valid as far as it went.)
Gawande is one of the giants of this whole healthcare reform phenomenon. I read somewhere that his landmark article in 2009 was required reading for everybody on staff at the White House.
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
A big part of the palliative vs. curative understanding is denial on the part of many that everyone eventually dies. It's a topic few want to discuss when all (meaning 100%) will face that final appointment. Even those who have come to terms with their earthly end frequently have someone important to them, unable to face that same reality, who simply refuses permission for them to go. As a non-medical caregiver I have seen more situations than I want involving protracted denial of mortality resulting in unnecessary expenses as well as the mental toll it takes on all
Posted by: John Ballard | October 26, 2012 at 07:05 AM