Futile and Low-Probability Cancer Care; Eliciting Patient Choices on Care
Posted Oct 06 2011 12:00am
A panel of academics has opined that the cost of cancer treatments is out of control (see: Dying cancer patients should not be given 'futile' drugs ). New medicines are coming to the market with little evidence to show they will significantly help patients. Doctors are said to be recommending new treatments with no thought about their cost or effectiveness because they don’t want to disappoint patients, leaving them with false-hopes. Below is an excerpt from an article discussing this problem:
A detailed report, published in The Lancet Oncology journal, said that in some cases it may be better for terminally ill patients to “forgo” these treatments in favour of better end-of-life care. The 37 experts...said that more money should be spent on diagnosis, so that diseases can be detected early and effective treatment given, as well as proven techniques such as radiotherapy. They warned that in order to avoid a “crisis” in medical care from the burden of cancer, the value of treatments must be calculated on the basis of cost. The final report of the Commission...stated: “Evidence shows that a substantial percentage of cancer care spending occurs in the last weeks and months of life, and that in a large percentage of cases, such care is not only futile, but contrary to the goals and preferences of many patients and families if they were adequately informed of their options. “Therefore, empowering patients through education and shared decision making can potentially improve care and lower costs. Specifically, when patients are informed that their cancer is life threatening, but there is a treatment available, many choose to be treated irrespective of personal costs, and certainly of costs borne by their insurer. “However, there is potential to improve care and reduce spending by empowering patients to forgo expensive and futile, or low-probability care when this matches their goals and preferences, and by empowering physicians to discuss these issues with their patients, and to recommend stopping disease-directed care when appropriate.”
For me, the words that jump off of this page are "futile" and "low probability" as they relate to the treatment of cancer. These are not words that cancer patients or their families want to hear. A key question for cancer patients is why their prognosis is hopeless and how the probability of improvement or cure is assessed. This is an extremely difficult conversation for patients and physicians alike and one that I suspect is often avoided or couched in imprecise language. Sometimes patients will raise the topic and sometimes physicians. For many patients and families, particularly the insured, the cost of care may confuse the issue. For me, the starting point for this conversation is to understand the treatment goals of the patient. Cost issues should then be introduced into the discussion.
A panel of academics has opined that the cost of cancer treatments is out of control (see: Dying cancer patients should not be given 'futile' drugs ). New medicines are coming to the market with little evidence to show they will significantly help patients. Doctors are said to be recommending new treatments with no thought about their cost or effectiveness because they don’t want to disappoint patients, leaving them with false-hopes. Below is an excerpt from an article discussing this problem:
A detailed report, published in The Lancet Oncology journal, said that in some cases it may be better for terminally ill patients to “forgo” these treatments in favour of better end-of-life care. The 37 experts...said that more money should be spent on diagnosis, so that diseases can be detected early and effective treatment given, as well as proven techniques such as radiotherapy. They warned that in order to avoid a “crisis” in medical care from the burden of cancer, the value of treatments must be calculated on the basis of cost. The final report of the Commission...stated: “Evidence shows that a substantial percentage of cancer care spending occurs in the last weeks and months of life, and that in a large percentage of cases, such care is not only futile, but contrary to the goals and preferences of many patients and families if they were adequately informed of their options. “Therefore, empowering patients through education and shared decision making can potentially improve care and lower costs. Specifically, when patients are informed that their cancer is life threatening, but there is a treatment available, many choose to be treated irrespective of personal costs, and certainly of costs borne by their insurer. “However, there is potential to improve care and reduce spending by empowering patients to forgo expensive and futile, or low-probability care when this matches their goals and preferences, and by empowering physicians to discuss these issues with their patients, and to recommend stopping disease-directed care when appropriate.”For me, the words that jump off of this page are "futile" and "low probability" as they relate to the treatment of cancer. These are not words that cancer patients or their families want to hear. A key question for cancer patients is why their prognosis is hopeless and how the probability of improvement or cure is assessed. This is an extremely difficult conversation for patients and physicians alike and one that I suspect is often avoided or couched in imprecise language. Sometimes patients will raise the topic and sometimes physicians. For many patients and families, particularly the insured, the cost of care may confuse the issue. For me, the starting point for this conversation is to understand the treatment goals of the patient. Cost issues should then be introduced into the discussion.