Most patients with incurable cancer still think they'll survive, study finds

[littlemissmartypants]

http://www.cbsnews.com/8301-204_162-57540242/most-patients-with-incurable-cancer-still-think-theyll-survive-study-finds/

Many patients who receive chemotherapy for incurable cancers still believe they can beat the disease, a new study suggests. The researchers behind the study question if patients are simply in denial or doctors are skirting the truth with their patients' prognoses.

The study, published Oct. 25 in the New England Journal of Medicine, looked at about 1,200 patients receiving chemotherapy for incurable lung and colon cancers.

http://www.nejm.org/doi/full/10.1056/NEJMoa1204410

CONCLUSIONS
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. (Funded by the National Cancer Institute and others.)

[GreenPartyVoter]

1. And so do many of their families. :^( (At least, that was how it worked in ours.)

[safeinOhio]

2. My friend has HCC, liver cancer.

Not good, but the doctors keep telling her she has a shot at beating it. The googles say not.

All I know is it is a roller coaster ride, up and down all of the time.

[Warpy]

12. That's the problem, doctors blowing smoke

up the asses of people whose quality of life they should be focusing on.

I burned out on oncology because of it. I got sick of seeing too many people getting aggressive treatment and hoping for a miracle instead of getting palliative treatment so they could live the rest of their lives in reasonable comfort. Aggressive treatment just ruined the time they had left.

I wish doctors would start being straight with their patients about this stuff, but I've seen too many oncologists with a savior complex, which is why we say cancer patients are "battling" cancer instead of just sick, something applied to any other illness.

The few studies that have been done have shown that patients getting palliative care have had longer lifespans than those going through heroics. They certainly managed to live those lives a lot better.

This doesn't mean I think heroics should be denied to people who know the whole story, far from it. People want to try everything, especially if they want to see their kids grow up, and I'd hate to see them deprived of the chance.

What I'm arguing for is more truth

[mjrr_595]

13. great post warpy

Well said

[newfie11]

3. There is always hope they could be the one

You never know who might beat the odds.

[gleannfia]

4. As a physician assistant who has worked in oncology

I can tell you that many of my attending MDs are absolute cowards when it comes to levelling with patients and their families. That, and their egos often get in the way-they cannot admit defeat. They make it about themselves and not the patient. I can't tell you how many times it fell to me to level with the patient (while the MD gets the big $$$) or the poor patient dies in the ICU when they could have died at home, surrounded by family. Sad, but true.

[Iwasthere]

6. Often about the money isn't it

The big C machine ... I have lost family to cancer, I studied all the options for years ... In my opinion if you have cancer, QUIT FEEDING IT! I know that sounds too simple to be true but it really is that easy. Quit feeding the tumors and they go away, or at least stop growing. They did a study of a large group of people that reached 100 years of age, they found that many of them had numerous types of cancer through their lives, if doctors found any of the instances of cancer they would have strongly encouraged them to cut the tumors out, poison whats left and get radiation, shortening their lives dramatically ... (The tumors are a symtom, we all actually have cancer in our bodies, just not big tumors).

Go to www.chrisbeatcancer.com Read all the comments by cancer survivors that beat uncurable without cutting, and poisoning their bodies

[Shivering Jemmy]

7. This bullshit you are pushing is dangerous

My mom is alive because of chemotherapy and radiation. I hope no one with cancer takes you seriously. Because that would make you their killer.

[Iwasthere]

8. Go to Chrisbeatcancer.com

Just read the stories ... they are inspirational, they don't ALL push 100% no chemo, just very wise people, and even doctors. We treat Oncologists like they are the ONLY solution.

[pipoman]

5. Initially, maybe..

as time goes by it becomes clear. My mother 2 years ago, my sister 2 months ago, both knew that their chemo was simply to extend the inevitable...bring their cancer marker numbers down which only indicates slowing of the growth of the tumor, not the absence of cancer. It becomes a decision between embracing their own mortality vs. the pain of continued treatment...at some point, almost every terminal cancer patient makes this decision.

[gleannfia]

9. You are correct

It is a fine line between crushing the patient's spirit and giving them false hope. My own father's lung cancer was so advanced when he was diagnosed, we knew treatment would only prolong his and our family's pain. That's not to say some cancers are not treatable and even curable. But for some cancers, once that process has started, it is impossible to arrest. It is best for the patient and his/her family to come to terms with this at the earliest point.

And, yes, it is a lot about the $$$. Especially for many private practice oncologists. In-office treatments, particularly with growth factor supplements and erythropoietin, are highly profitable. And I'll say it again: Many oncologists are cowards.

[bananas]

10. Will-to-live is a strong predictor for survival irrespective of comorbidities.

http://ageing.oxfordjournals.org/content/early/2012/06/28/ageing.afs082.abstract

Will-to-live and survival in a 10-year follow-up among older people

Helena Karppinen1,2?,
Marja-Liisa Laakkonen1,3,
Timo E. Strandberg4,5,
Reijo S. Tilvis6 and
Kaisu H. Pitkälä1,2

+ Author Affiliations

1Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
2Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
3Helsinki Health Centre, Laakso Hospital, Helsinki, Finland
4Department of Health Sciences/Geriatrics, University of Oulu, Oulu, Finland
5Unit of General Practice, Oulu University Hospital, Oulu, Finland
6Clinics of General Internal Medicine and Geriatrics, Helsinki University Central Hospital, Helsinki, Finland

Address correspondence to: H. Karppinen. Tel: [phone]; Fax: [phone]. Email: [e-mail]

Received September 26, 2011.
Accepted April 5, 2012.

Abstract

Background: there is little research how older people's will-to-live predicts their survival.

Objective: to investigate how many years home-dwelling older people wish to live and how this will-to-live predicts their survival.

Methods: as a part of the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study, 400 home-dwelling individuals aged 75–90 were recruited into a cardiovascular prevention trial in Helsinki. In 2000, a questionnaire about the wishes of their remaining life was completed by 283 participants. Participants were inquired how many years they would still wish to live, and divided into three groups according to their response: group 1: wishes to live <5 years, group 2: 5–10 years, group 3: >10 years. Mortality was confirmed from central registers during a 10-year follow-up. The adjusted Cox proportional hazard model was used to determine how will-to-live predicted survival.

Results: in group 1 wishing to live less than 5 years, the mean age and the Charlson comorbidity index were the highest, and subjective health the poorest. There were no differences between the groups in cognitive functioning or feeling depressed. Mortality was the highest (68.0%) among those wishing to live <5 years compared with those wishing to live 5–10 years (45.6%) or over 10 years (33.3%) (P < 0.001). With group 1 as referent (HR: 1.0) in the Cox proportional hazard model adjusting for age, gender, Charlson comorbidity index and depressive feelings, HR for mortality was 0.66 (95% CI: 0.45–0.95) (P = 0.027) and 0.47 (95% CI: 0.26–0.86) (P = 0.011) in groups 2 and 3, respectively.

Conclusion: the will-to-live was a strong predictor for survival among older people irrespective of age, gender and comorbidities.

[Laffy Kat]

11. Denial can be therapeutic for some people.

It's also a stage of grief. So some people who think they can beat it may not be ready to accept the truth.