A Lack Of Patient Support For Those Who Choose No Cancer Intervention.

A recent study suggests that patients who ask for no cancer intervention face unsupported responses from doctors, family and friends.

In a telephone interview with researchers, 12 of 18 study participants (with small, asymptomatic or suspected thyroid cancers) who had decided against cancer intervention, reported responses that were not supportive.

Responses included being told by doctors, friends, and others that they were “being stupid,” “were wrong,” or were “crazy.”

One participant told the researchers that

“Deciding not to have surgery in the world where I live is kind of like deciding to jump off a bridge…. I was making a decision against opposition from everyone.”

These responses would likely contribute to a patients’ anxiety about their cancer progression and can lead to feelings of isolation.   In addition, some could stop monitoring their cancers altogether.

Why would patients ask for no cancer intervention?

The worry of over diagnosis can prevent patients from follow-up cancer intervention to confirm disease or the disease status

In recent years, concern has increased about the over diagnosis of cancer. These include prostate, breast, and thyroid cancers and can present challenges to both doctors and patients.

Currently, doctors cannot reliably predict which cancers will progress.  This can lead to uncertainty for doctors and their patients.  The acknowledgment that unnecessary treatment of cancers, known as over treatment, may lead to harmful side effects could be preventing some patients from immediate biopsy and no further intervention.

Mistrust of doctors or the pharmaceutical profession

Big pharma’s recent troubles have fostered consumer mistrust and a negative view of the industry.  However, it wasn’t that long ago that the pharmaceutical industry was considered among the most respected industries.  It is beyond the scope of this article to discuss the pros and cons about the pharmaceutical industry.  We suggest that the first place you look, before reading about all the conspiracy theories is the comprehensive Wikipedia site about Pharmanoia 

The requirement for a good quality of end of life can be greater than the need for cancer intervention

The question of when to stop treatment for people with a cancer which continues to grow despite all efforts, is a very hard choice.  A study in 2015 suggested that many people have worse quality of life after receiving  end-of-life chemotherapy.  Therefore, guidance from the American Society of Clinical Oncology (ASCO) recommends that palliative chemotherapy is not given to people diagnosed with growing disease who are very sick.  However, people diagnosed with growing cancer who are in relatively good health and self-sufficient, are recommended palliative chemotherapy to ease pain or help the person live longer.

There is an assumption that cancer therapies at end of life can kill you

There is no evidence that there is a difference in survival between the people who get palliative chemotherapy and people who don’t.  So at the moment there is no proof for this hypothesis.

But there are no hard and fast rules. Whilst some people prefer to receive treatment up until the last day of their lives, others will stop cancer intervention, preferring to spend the last weeks or months of their lives with their families without having to deal with being in treatment anymore.

Wise decision-making

Dr Charles Blanke, and Dr Erik  Fromme, M.D.both of Oregon Health and Science University said that

“Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment,”

“Patients with end-stage cancer are encouraged by friends and family to keep fighting, but the battle analogy itself can portray the dying patient as a loser and should be discouraged. Costs aside, we feel the last 6 months of life are not best spent in an oncology treatment unit or at home suffering the toxic effects of largely ineffectual therapies for the majority of patients.”

Understanding the patient experience

“These findings highlight the need to better understand external pressures that cancer patients may experience.”

said Ashley Wilder Smith, chief of NCI’s Outcomes Research Branch in the Division of Cancer Control and Population Sciences.

“We need to better understand the patient experience, regardless of what people decide to do about treating their cancer.”

Articles sources

Dr Shara Cohen

Dr Cohen started her working life as a research scientist and lecturer with over 100 peer-reviewed scientific publications.

She followed a classical scientific career until she left mainstream science in 2000 (which coincided with the birth of her first daughter) to establish the Life Science Communications company, Euroscicon Ltd.

Euroscicon Ltd was her first company (which she sold in 2016).

In 2013 she was diagnosed with Cancer and set up Cancer Care Parcel

She also works with and establishes businesses and charities which benefit local, national and international communities via her company – The Pein Consultancy Ltd

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