Terminal cancer as cash cow

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Several women in my breast cancer survivors group are Stage 4. Their cancers have spread. They are receiving various therapies. Some are doing relatively well. Others, not so much.

One of the most intelligent women in the group began having serious chest pain a couple of months ago. She’s over 60 and received a cardiac workup that revealed that nothing was wrong with her heart. She also had severe back pain. After a few false starts, she received an MRI which revealed a 4" x 2" x2" tumor behind her breast bone and pressing against her heart. She also has metastases in her spine (2 vertebrae fractured) and forearm.

Over the past couple of weeks, she received 10 radiation treatments that seriously damaged her esophagus, preventing her from eating. She was in excruciating pain but didn’t get adequate pain meds. She is starting a new, twice daily chemo pill which is causing her side effects.

I’m heartbroken for her. She’s clearly terminal since the tumors are inoperable. The new chemo pills are extremely expensive and not covered by Medicare. Most chemo drugs at this stage only extend life by a small amount, if any, in clinical trials.

But in many cases, the doctors don’t tell patients they are terminal. A 2021 survey of oncologists showed that just 17% follow guidelines that recommend they refer a patient diagnosed with metastatic disease to palliative care — and these same oncologists acknowledged that early introduction of palliative care leads to better patient outcomes.

Terminal cancer patients are treated as cash cows.

https://www.statnews.com/2022/09/02/people-terminal-cancer-s…

**People with terminal cancer need to know they are dying. Doctors shouldn’t withhold that information**

**By S. Monica Soni, Stat News, Sept. 2, 2022**

**...**
**Unrealistic expectations fueled by direct-to-consumer pharmaceutical advertising depicting happy cancer survivors and the pharma industry’s influence on oncologists hang over patient-doctor conversations. For every truly game-changing new drug or treatment indication, dozens of others offer just days or weeks of additional survival — if any — but at additional costs of hundreds of thousands of dollars and false hope.**

**The Food and Drug Administration’s accelerated approval track, which was meant to help people with serious illnesses receive beneficial therapies sooner than the traditional review process, may cost more than it helps. Medicare spent an estimated $569 million between 2017 and 2019 on cancer drug indications that didn’t improve patients’ overall survival. Oncology, sadly, is a cash cow. From 2010 to 2019, revenue generated from cancer drugs increased 96% for the 10 largest pharma companies, and in 2019, cancer drugs made up 27% of their total revenue....**

**Before patients agree to chemotherapy riddled with unpleasant or harmful side effects, they should have a complete picture of what it will gain them in terms of months of life, quality of life, and symptom burden. For themselves, physicians are overwhelmingly likely to choose non-aggressive care at the end of their lives and up to one-third of oncologists wouldn’t accept the chemotherapy they prescribe. ...** [end quote]

I posted this information in my survivors group with a trigger warning. Understandably, many patients who are struggling and fighting as hard as they can want hope. It takes strength of will to accept that death is inevitable and hope is not a good reason to bankrupt the family.

All health decisions are highly personal, especially end-of-life decisions. Even the most effective treatments only help a few. That’s especially true of chemo drugs.

www.thennt.com

Personally, I would want to know the true situation for myself. Palliative care and assisted suicide are reasonable options in terminal cancer but they don’t make money for oncologists or Big Pharma.

Wendy

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We went through this trauma with my father. His sister didn’t want him to know, I was of the exact opposite opinion, he was a man who had taken great risks in NAZI Germany and I was of the opinion that he had the right to decide for himself about his future. My mother and I talked to the surgeon who was going to operate to discuss this issue. I asked the doctor who should tell my dad about his condition. The doctor said that he was best prepared for the task. Before the operation my father effectively said goodby to me saying he had lived a good life the way he had wanted to live it.

The Captain

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Terminal cancer patients are treated as cash cows.

Patients become cash cows when faced with their own imminent mortality. To quote a Kenny Chesney song “everybody want to go to heaven but nobody want to go now”.

Unfortunately I’ve had those discussions with families/patients in situations where it was blatantly obvious even to non-medical people that it is over. But they almost always opt for the one last chance. Guess it eases the conscience when “everything is done”.

Hospice care does need to be discussed and explained more frequently.

JLC

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"I posted this information in my survivors group with a trigger warning. Understandably, many patients who are struggling and fighting as hard as they can want hope. It takes strength of will to accept that death is inevitable and hope is not a good reason to bankrupt the family.

All health decisions are highly personal, especially end-of-life decisions. Even the most effective treatments only help a few. That’s especially true of chemo drugs."

My BIL was diagnosed with pancreatic cancer five years ago. He was 69. Unfortunately his side of the family had a lot of cancer deaths in the family tree.

He was diagnosed in Dec. the prognosis is not good. Only 5% make it five years and most are dead within a year.

If you do nothing, you’ll be dead in a few months.

Well, he had a wife and grown kids and grandkids, and decided to do ‘whatever necessary’ to fight it

Had operation. Had Chemo and radiation. Not functioning well. Episodes in the hospital. All sorts of complications from nausea and not being able to eat and keep food down, lost weight. In the 8 months he survived, lots of trips to emergency room, lots of time spent getting chemo, radiation. No improvement and steadily downhill. My sister quit working to take care of him full time. Didn’t make it 8 months despite all the heroics.

Then again, Alex Trebec (of Jeopardy! fame) fought it for a few years, finally succumbing to it.

Some cancers nastier than others.

Breast cancer can get women early - in their 30s and 40s. Most survive it but some don’t not matter what is done.

I dunno. It’s possible my BIL might have made it years, but a lot of cancers are hard to detect. Pancreatic cancer is one - often you are really far gone by the time you have symptoms and it is found.

It’s amazing that 10% of the US population still smokes - which takes 13 years off the average life expectancy - often resulting in lung and other cancers, lung problems, etc. My grandfather was a smoker and enjoyed his pipe. Got throat cancer in late 60s and was gone a few years later. Not much cancer treatment back in the 1950s.

cancer is not a fun way to go, but you can eat a healthy diet that contains anti-cancer fighting foods. Greens, beans, onions, mushrooms, berries, nuts and seeds. Eliminate sugar from your diet and ‘processed foods’. Wild caught fish.

https://www.drfuhrman.com/blog/237/g-bombs-the-anti-cancer-f…

t.

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cancer is not a fun way to go, but you can eat a healthy diet that contains anti-cancer fighting foods. Greens, beans, onions, mushrooms,
berries, nuts and seeds. Eliminate sugar from your diet and ‘processed foods’. Wild caught fish

…and still succumb to cancer. Or any number of other diseases that can strike down folk who’ve been perfectly good custodians of their bodies.

The reason why the drfuhrmans, mercolas etc. etc of this world make the coin they do off those patients who’re terminally ill and desperate to find a “cure” or some alternative to accepting the end of their life…is that they’re desperate to find a cure and an alternative to the honest prognosis that their physicians have given them. Anyone who’s spent time on the H&N board over the past decades could attest that there’ve been any number of posters looking for opinions on some alternative to “conventional” medicine when they perceive it’s failed them. Rather than complaining that they’re the victims of too much futile care, it’s usually that all avenues haven’t been explored.

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Wendy,

I agree that terminal cancer, and many other health issues are cash cows. Sometimes a person can be lucky - with the right treatment and great insurance coverage - what may be like miracles, can happen.

When my brother (three-years older than me and in his early 60’s) got a chest x-ray in preparation for a scheduled minor surgery, they saw something on his lungs and asked him to come in for a CT scan. The CT scan proved that there were multiple lumps in his lungs. After a painful biopsy, he was diagnosed as having Stage 4 Melanoma. He suspects that the Melanoma originated from skin lesions that he had been treated for occasionally. His skin cancer from having “fun in the sun” when he was younger and living in TX.

He had targeted radiation and his oncologist tested him to see if he would respond to what was then, a new immunotherapy treatment called Opdivo. It’s expensive stuff, but his insurance company approved it and he started treatments. https://www.opdivo.com

Between the radiation and treatments, he suffered only minor side effects - a dry throat mainly. That was two years ago. He has rung the bell and has been cancer free. He now volunteers with a local cancer organization to assist patients who are undergoing cancer treatment currently.

Sometimes it works, and the investment is totally worth it. Thank goodness in my brother’s case he ended up a winner.

I can only that hope your friend has similar outcomes.

'38Packard

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Wendy,

First and foremost, I am sorry you are going through this with your friend and co-combatant.

But in many cases, the doctors don’t tell patients they are terminal.

My dearest uncle, a second father to us, was diagnosed with lung cancer. Not a huge surprise given all the smoking in his life and working for Corning Fiberglass. The doctors told him it was terminal and that he had a year to live. This was in his mid-60’s, IIRC.

There is nothing quite so sad as watching hope leave a person. This brave Marine with the barking bulldog tattoo on his arm withered and died almost one year to the day.

My brother was diagnosed with Burkitt’s Lymphoma around the same time, about the age of 35. Doctors thought for sure he wouldn’t live a week, but Bro’s stubbornness and determination beat those odds. He is written up in a textbook, literally, as a miracle cure. Sadly he later got prostate cancer in his 60’s and eventually died from it spreading to his bones and bladder.

I often wondered if Uncle would have made it if he hadn’t been told he was terminal. Like a good soldier he followed orders and respected authority. Being told he had a year to live may have kept him from going past that year. It’s complicated.

IP

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I don’t think doctors give poor advice out of avarice. I think they are just not willing to give up.

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I think it’s clear that the majority of the nation’s health care costs come in the last few years of life - much of it flutily spent (frequently through decisions made by family members who don’t want to give up without trying every possible route).

Unfortunately, the adjudication of whether these measures are “worthwhile” by a government agency (or statute) has been poisoned by the term “Death Panel”.

Jeff

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Personally, I would want to know the true situation for myself.

While the setting was quite different, I was fortunate to have a plain speaking doctor taking care of my wife in her final days. When I asked about her future, he clearly told me she had none - that her condition was terminal.

It is terribly hard to hear, but it’s also vital to know.

Cancer patients and their families and loved ones deserve no less clarity.

There is probably a bit of shared responsibility here. I’m sure a few cancer doctors are indeed recommending treatments just for the revenue. I suspect that is a small minority, though. I’d guess that a great majority are simply not being as blunt in their assessments as they should be. And patients then take advantage of that to hear a glimmer of hope where there may be none. And since the treatment decisions generally hinge on the patient’s wishes, we end up with plenty of treatments being done where they probably shouldn’t happen.

–Peter

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<I think it’s clear that the majority of the nation’s health care costs come in the last few years of life - much of it flutily spent >

“futilely” or “fruitlessly” :wink: (they’re not playing the flute LOL)

Spending in the last year of life accounted for 27.4 percent of all Medicare outlays for the elderly, similar to the 26.9–30.6 percent range in earlier decades.

Medicare starts at age 65. The average life expectancy in the U.S. is 79 years.

If they die anyway, the spending is futile.

Wendy

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I’m sure a few cancer doctors are indeed recommending treatments just for the revenue.

This kind of thing is very difficult to discuss. And sorry about your wife.

About a year ago we had a family friend who died at 95. Didn’t die from cancer (just got old), but she left her house to Stanford for cancer research. why? Because her husband died from cancer ~30 years ago and they were able to extend his life by ~6 months for which she was forever grateful. She had a will drawn up before he passed with these wishes.
When the time came we contacted Stanford and it turns out they have a standardized procedure for handling this – so it must happen fairly often.

Mike

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I think it’s clear that the majority of the nation’s health care costs come in the last few years of life

That isn’t really the problem. The problem is self-inflected…an unwillingness of Americans to behave responsibly.

As of 2020 it is estimated that about 50% of Americans have chronic diseases, which account for a whopping 86% of health care costs. Much of these chronic diseases are avoidable, which means that Americans essentially choose to get sick by refusing to exercise and eat healthy. Diabetes, heart disease, and high blood pressure can largely be avoided by changes in lifestyle.

According to one estimate the annual direct health costs for a patient with a chronic disease is about $6,000 or 5X that of a person without a chronic disease.

Obesity is the single biggest risk factor for chronic disease and accounts for over 40% of direct health care costs.

Hate to say it and it is not PC or nice, but it may be that the only way to control health care costs is a national program of “fat-shaming”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7077778/#:~:tex….

https://www.americanactionforum.org/research/chronic-disease…

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Unfortunately, the adjudication of whether these measures are “worthwhile” by a government agency (or statute) has been poisoned by the term “Death Panel”.

Jeff,

There are a lot of things ‘poisoned’ in this way.

The country has fully figured that out. We are keeping score.

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As of 2020 it is estimated that about 50% of Americans have chronic diseases, which account for a whopping 86% of health care costs.

A few days ago, I wandered through a nearby mall and commented to my wife that every single person we passed was somewhere between fat and morbidly obese. I wonder if this accounts for the appalling number of deaths per 100K that the US suffered in the COVID pandemic compared to countries whose populations were thinner on average. They used to say that “eat your peas because children are starving in China”, but on a whole, Asian countries did far better than we did.

https://coronavirus.jhu.edu/data/mortality

Jeff

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I don’t think doctors give poor advice out of avarice. I think they are just not willing to give up.

Whose Life Is It Anyway? is a play that illustrates this conundrum perfectly. I had the good fortune of being on the crew of an amateur theater group that staged it in Caracas. It made me think deeply about this issue. There is no good reason for the expert to dictate our lives. Advise yes, but not dictate. Whose life is it anyway?

Whose Life Is It Anyway? (play)
Plot[edit]

Set in a hospital room, the action revolves around Ken Harrison (Claire Harrison in some later productions), a sculptor by profession, who was paralysed from the neck down (quadriplegia) in a car accident and is determined to be allowed to die. Clark presents arguments both in favour of and opposing euthanasia and to what extent government should be allowed to interfere in the life of a private citizen. In portraying Ken as an intelligent man with a useless body, he leaves the audience with conflicting feelings about his desire to end his life.

https://en.wikipedia.org/wiki/Whose_Life_Is_It_Anyway%3F_(pl…

The Captain

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If they die anyway, the spending is futile.

obviously they will die anyway. the death rate is after all 100%.

c.

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“Hate to say it and it is not PC or nice, but it may be that the only way to control health care costs is a national program of “fat-shaming”.”

Back in the 1950s and 60s, only a small percent of people were ‘obese’.

Now, I look at teens and at least one third of them are packing 50-100 lbs extra fat around.

You go to all your can eat pizza places and the Asian buffet, it must be 50% there are way, way overweight.

If your fat as a teenager, you’re likely going to be ‘fat’ all your life. Of course, with all the “PC” crap, ‘fat’ is ‘accepted’ as a ‘fact of life’ and ignored.

In the 1960s, soda came in 6oz bottles. Maybe 8 oz if a Pepsi. Now, a 99 cent Big Gulp at 7-11 is 32 oz of HFCS infused 800 calorie ‘soda’. Simple math.

t.

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“Hate to say it and it is not PC or nice, but it may be that the only way to control health care costs is a national program of “fat-shaming”.”

In a sense, the current overabundance of body fat is a consequence of fat-shaming… dietary fat, that is.

Replacing fat calories in your diet with carbohydrate calories probably means you’re eating more calories, because the carbs don’t signal “I’ve had enough” the same way.

There is a minimum amount of protein (and of a few specific proteins) you need to eat in order to stay healthy. Not getting it will be harmful in the long run, even if you’re getting enough of all other nutrients and getting enough total calories.

There is also a minimum amount of fat that you need to eat in order to stay healthy.

There is no minimum amount of carbohydrates. You can stay perfectly healthy and have a long life with ZERO carbs.

And it was our dear government that would never lead us astray, that really pushed the stop-eating-fat crusade and told us to stuff ourselves with carbs instead.

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The human race has fat shamed since the beginning of time. There have always been plenty of people in denial. SM makes it possible for the fatties to all agree that extra sized is not unattractive. Sure, heavy sarcasm.