Cancer Drugs Found to Not Be Worth Expense
A recent study from the National Cancer Institute has found that most cancer drugs are not worth the money. For instance, Erbitux, the drug used for the treatment of lung cancer, extends life by only an average of 1.2 months, hardly worth the expense of $80,000 for treatment. The authors calculated that extending life by one year for the 55,000 Americans who die of cancer would cost $440 billion. Other examples of basically useless treatments that will cost you the farm include Avastin and Nexavar, both costing more than $34,000 for a course of treatment.
Of course the usual suspects were trotted out in the form of doctors who stated that for some patients Erbitux is a miracle.
More egregious practices mentioned included doctors using drugs off label or aggressively treating people with Mercedes like drugs who had advanced stages of cancer. Of course Americans don’t like to talk about rationing of healthcare, which Rick Lippin MD has been talking about in the email circuit as well as the fact that more care can be worse care, and that profiting off of the dying should be prosecuted as a crime.
Hear, hear! (or is it Here, here?)
Maybe we as doctors should teach people to grieve their dead and dying, rather than enable them to flee from reality by throwing our expensive technology at their loved ones and colluding in the myth that everyone can live forever (e.g. “Aunt Mabel is fighting her cancer and gonna win” kind of nonsense).
Hat tap to John Mack (@pharmaguy).
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By Gianna, July 1, 2009 @ 10:03 am
I watched my brother die because of his cancer treatment…cancer is a big money making industry just like psychiatry…it’s sickening.
I read somewhere that people who choose not to treat with chemo live longer on average than those who do treat…
I don’t know where I read that and I don’t know if it’s actually true…
obviously we know there are some cancers that when caught early enough do respond well to toxic treatments…but I would not be at all surprised if the above is true for most cancers.
what say you, doctor?
By Doug Bremner, July 1, 2009 @ 10:34 am
Most cancers that have metastatized (except for breast, prostate, thyroid, some lymphomas) treatment will not lead to a clinically meaningful extension of life.
By David Diamond, July 1, 2009 @ 10:37 am
This is an important comment on the ineptitude of the cancer research industry to accomplish positive cost effective outcomes in cancer treatment.
I have not seen a study that has contrasted outcomes of patients treated with versus without chemo, but I wouldn’t be surprised to find no difference, or even better survival w/o chemo
Indeed, I’d like to see the original research justifying the use of chemo at all.
More importantly, I’ve been lobbying to get a clinical trial started at my university (U So. Florida) at the Moffitt Cancer Center for what should be an effective treatment for a broad range of cancers, but the folks here aren’t interested. The basis of the trial is the well-established finding that cancer cells, in general, are totally dependent on glucose for energy – unlike normal cells which can switch to use ketones and/or fatty acids in the absence of glucose.
A clinical trial needs to be done in which people with cancer are put on a ketogenic diet, which should slow and even stop tumor growth. This is a tough one to get funded since it doesn’t involve drugs, and diet manipulations are not in favor with funding agencies. I would welcome discussing this idea, and a related strategy I have, with anyone who has an interest in supporting this study.
David Diamond
By Gina Pera, July 1, 2009 @ 11:46 am
Interesting idea, David. In fact, I’ve wondered why such a study, on that glucose-deprivation theory, hasn’t been attempted.
Before the conspiracy theorists go to town on their “BIG BAG PHARMA” bandwagon, I’d suggest the problem is more elemental and systemic — as a whole, scientists are novelty and complexity driven; they largely aren’t compelled by thoughts of “simple” solutions. Their brains just don’t seem to work that way. In fact, Asperger’s Syndrome is often called The Scientific Profile, and perhaps with good reason.
They often overlook the obvious sometimes, wrongly assuming that if the solution were so simple — if the means to achieve it already exists — it would have been done already. Perhaps there is also a bit of ego involved, no doubt financial incentive in some cases (but certainly not all….some scientists view money in such abstract terms it’s a wonder their bills get paid).
There’s a lot more glory in discovering, say, a statin, than in understanding how B vitamins and magnesium might accomplish the same thing but with fewer side effects and broader positive effects. After all, someone a long time ago (presumably) discovered these effects; where’s the discovery there?
Just my limited observations.
By Orac, July 1, 2009 @ 11:51 am
Two points:
First, you missed at least a couple: There’s metastatic colorectal cancer, for which survival has increased markedly over the last decade or so, thanks to FOLFOX and Avastin. This is particularly true for colorectal cancer metastatic to the liver. Indeed, my friend’s father is one example of this. He had liver metastases from colorectal cancer and later popped up with lung metastases. Thanks to these drugs, he’s been percolating along for nearly three years, playing golf two or three times a week in Florida. Ten years ago, he would almost certainly have died already.
Let’s see. There’s also testicular cancer, where aggressive chemotherapy and radiation can cure stage IV disease (Lance Armstrong, for instance).
Second, who defines “clinically meaningful”? That’s so vague as to be meaningless.
By Doug Bremner, July 1, 2009 @ 12:45 pm
OK, I was just winging it off the top of my head, thanks for the additions. As for “clinically meaningful” I admit that is a lame phraseology. Something less than six months, and certainly 1.2 months, I think counts as not being of much merit, especially if it makes you throw up all the time.
By Doug Bremner, July 1, 2009 @ 12:47 pm
The Brits pay $50,000 per year of life extended. Before you start beating your chests about healthcare rationing consider this: Is it worth tanking our economy so we can give Aunt Mildred a treatment that will extend her life by a month?
By Tom Nesi, July 1, 2009 @ 5:32 pm
Excellent reporting. I wrote this Op-Ed for the NY Times years ago. The situation now is pathetic. I am the author of “Poison Pills, The Untold Story of the Vioxx Drug Scandal.”
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False Hope in a Bottle
By Tom Nesi
Published: Thursday, June 5, 2003
Seven months ago, I made the decision to hasten the end of my wife’s life. Susan lay in an irreversible coma and had not been fed for 10 days; she was being kept alive solely by fluids. An old family friend stopped by with advice that no one in the medical profession had been able to offer.
”You need to stop giving your wife liquid,” he said.
I shook my head. ”You cannot deprive a living being of water,” I said.
”Your wife is no longer with us,” he said. ”She died of a brain tumor two weeks ago. Susan needs to rest now.”
I still refused to accept the fact and called several of Susan’s doctors and members of our family. Each of them reaffirmed that withholding fluid was the humane decision. Indeed, in her living will Susan had spelled out that she did not want ”artificial prolongation” of her life either through nutrition or hydration.
For about a year, Susan had been offered numerous medications, including, in the latter stages of her illness, Iressa, which last month was approved by the Food and Drug Administration despite limited data about its effectiveness. Two other experimental drugs, Avastin and Erbitux, are now going through the F.D.A. approval process. With the release last week of new clinical studies, many believe the chances of approval have greatly improved. The process will likely be helped by the F.D.A.’s new program, unveiled this week, to work with the National Cancer Institute to accelerate the development and approval of cancer drugs.
It is hard to argue against making new cancer drugs available to the desperately ill. Certainly, these drugs are a step in the right direction in the fight against the disease. But so far they have been proved only to extend life by a few months in patients whose cancer has been diagnosed as virtually incurable. I think we need to ask ourselves whether offering terminal patients limited hope of a few more months is really beneficial. The question is not whether days are extended, but in what condition the patient lives and at what emotional and financial cost.
My wife was discovered to have glioblastoma, a deadly form of brain cancer, in August 2001. She was 52. The average survival time for patients with this disease is about 11 months. We, of course, hoped for more time.
Susan was treated at a prestigious medical center with access to a wide array of innovative drugs, including a Gliadel wafer, which delivered chemotherapy directly to the site of her tumor. On average, we were told, this treatment extends life by about two months. But Susan suffered a great many problems over the next few horrific months. She was hospitalized five more times and had two more brain surgeries. After a third surgery, she had a stroke that left her almost totally paralyzed and unable to speak or eat — leaving me with the decision to take her off life support.
But according to the medical profession, the experimental treatment had worked. Susan lived almost three months longer than the average patient with glioblastoma. Somewhere in some computer database, Susan’s experimental regimen will be counted a success. She was a ”responder.” And therein lies the terrible truth behind the approval of ”miracle drugs” on the basis of ”tumor shrinkage” or ”extended days.” Susan’s life was extended. But at what cost?
During those final months, we incurred expenses for four ambulance trips, two weeks in a critical care center, a full-time home health-care aide, a feeding tube and electronic monitor, home hospital equipment, occupational therapists, social workers and medication. My wife’s treatment cost at least $200,000 (most of which, fortunately, was covered by insurance). I had to greatly curtail my work schedule and hire someone to handle the myriad bills.
I still hear the words of my wife’s surgeon after her disastrous third surgery: ”We have saved your wife’s life. . . . We have given you the ability to spend more quality time with your loved one.” And the words she scribbled on a notepad two weeks later: ”depressed . . . no more . . . please.”
Susan’s last half hour was peaceful. We gave her morphine. Her eyes fluttered. I held her hand. Finally, her breathing stopped. On the table next to her were hundreds of pills, nutrition bottles, vials, needles. No longer needed.
Drawing (Doug Fraser)
Tom Nesi, a former director of public affairs at Bristol-Myers Squibb, is president of TJN Communications, which produces health-care educational materials.
A version of this op-ed appeared in print on Thursday, June 5, 2003, on section A page 35 of the New York edition.More Articles in Opinion >
By Doug Bremner, July 1, 2009 @ 8:25 pm
Thanks Tom for sharing this touching piece about your wife. I am sorry for your loss. Your honesty is refreshing. We need more people like you to speak up. Adding two more months spent in misery is not an acceptible outcome. I will send your story out again through our distribution list.
By Dan, July 1, 2009 @ 9:21 pm
I heard Dr. Roy Vagelos, former CEO of Merck, spoke at Washington University in St. Louis some years ago about this very topic. He felt the cost did not justify the benefits of biologics used as therapy for oncology patients, overall.
By carolyn, July 2, 2009 @ 10:18 am
these comments take my breath away. like Gianna, i believe that my friend abe died, not of cancer but of cancer treatments.
i agree with gina that sometimes it’s not a conspiracy but rather just a case of researchers fixated on the wrong “prize.” although when the AMA, FDA & NCI suppress alternative research (think gerson, burzynski, kelly, gonzales) there is definately malice intended.
yes, dr diamond, when my friend was in MSKCC, i would run through the halls shouting “if these people had any interest at all in curing cancer, they would of be serving coca cola at every meal!” abe’s oncologist said to me that he knew “nothing about nutrition.”
as for tom, ugh! i’m so sorry. your story was heart breaking. i’m sure you live with the pain everyday. thank you for sharing it
By carolyn, July 2, 2009 @ 10:23 am
these comments take my breath away. like Gianna, i believe that my friend abe died, not of cancer but of cancer treatments.
i agree with gina that sometimes it’s not a conspiracy but rather just a case of researchers fixated on the wrong “prize.” although when the AMA, FDA & NCI suppress alternative research (think gerson, burzynski, kelly, gonzales) there is definately malice intended.
yes, dr diamond, when my friend was in MSKCC, i would run through the halls shouting “if these people had any interest at all in curing cancer, they would NOT be serving coca cola at every meal!” abe’s oncologist said to me that he knew “nothing about nutrition.”
as for tom, ugh! i’m so sorry. your story was heart breaking. i’m sure you live with the pain everyday. thank you for sharing it
and Dan, i find it interesting that Dr. Roy Vagelos was the FORMER CEO of Merck when he made that comment. too bad he didn’t say it when he was acting CEO. the trouble with corporate mentality is that everyone defends the corporation while they are a part of it and acknowledge the wrongdoings only after they’ve left and cashed in their stock options. it’s easy to act on your conscience when you are out of the firing line
By David Diamond, July 2, 2009 @ 10:36 am
It’s remarkable to me that oncologists know so little of nutrition – an area that gets no respect from docs or funding agencies
Years ago I watched as my mother-in-law ate ice cream daily as she was dying from lung cancer. Had I known then that cancer cells thrive (depend)on sugar I would’ve intervened.
the more you read on the topic, the more apparant it is that cancer and heart disease are caused by excess carbs –
someone needs to do a clinical study on this —–