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.
**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.
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.