Is it possible to over treat cancer?
New reports show that some physicians are over prescribing patients, meaning patients are getting extra tests and possibly treatment that goes beyond what they actually need. But there are those doctors who try to defend this practice by saying better safe than sorry. Patients want to know whether the overtreatment plan is prescribed to them for altruistic reasons or whether it is another hospital moneymaking scheme. Not only could physicians be causing patients extra money but also extra pain and suffering.
CNN reports on this growing issue.
Overtreatment has been a problem in the United States for a while now. Apparently it is particularly prevalent among prostate cancer patients.
What is prostate cancer? It is a serious disease and fairly prevalent in the United States. In 2014 alone, the American Cancer Society predicts that, 233,000 men will be diagnosed with prostate cancer and 29,480 will die of it. Two important studies showing how prostate cancer is treated in the U.S. were published in the journal JAMA Internal Medicine this week.
The results should cause those who treat prostate cancer and the organizations that advocate for prostate cancer awareness to take notice of the treatment plans. The studies surprisingly found that a large number of American men with prostate cancer get unnecessary and aggressive treatment, and many of these men have no idea of this. In some of these cases, the treatments are actually known to be fruitless and even harmful to a person’s health.
In one of the studies, which lasted more than twenty years and involved more than 60,000 men diagnosed with cancer confined to the prostate, found that initial treatment with anti-androgen hormonal therapies is common. This particular study also affirmed previous research showing that this treatment plan, in this population, does not extend a person’s life.
Why is this treatment inappropriate and harmful for many?
This is a treatment that is useful for a small, well-defined group of men who are suffering from prostate cancer. But it is a superfluous and damaging treatment for the majority of American cancer patients who are prescribed with it.
What are the side effects?
The hormones utilized in the therapy tend to cause hot flashes, muscle weakness, osteoporosis and impotence in all who get it. If that is not enough, these drugs also increase a man's risk of diabetes, cardiovascular disease and death from cardiovascular disease (heart attack).
How was the second study conducted?
It showed that there is a large difference in how physicians treat good-prognosis (low-grade, less aggressive) cancer confined to the prostate, meaning that there is a lack of consistency. A significant number of patients get harmful and aggressive surgical or radiation therapies.
What are the dangerous side effects of these?
These therapies can cause urinary and bowel incontinence, sexual impotence and, in some cases even death.
Various studies in the U.S. and Europe have proven that there is a form of prostate cancer that is localized to the prostate and of good prognosis, meaning it rarely develops further or causes significant damage if left untouched.
What do cancer research groups recommend?
CBS reports, “All of the organizations that set treatment guidelines based on scientific evidence recommend that men diagnosed with this type of cancer are carefully observed. These cancers can be effectively treated if found to be progressing. With careful observation, the majority of men will never need treatment and can be spared the burdens of unnecessary therapy. Low-risk forms of prostate cancer are commonly diagnosed through screening and usually over treated in the U.S. The massive problem of overtreatment and the resultant large number of harms to the population is part of the reason that a number of respected organizations such as the U.S. Preventive Services Task Force and the American Academy of Family Physicians now recommend against routine prostate cancer screening.”
Are doctors recommending overtreatment for profit?
A 2010 study actually demonstrated that hormonal therapy use consistently increased throughout the 1990s. Interestingly, usage went down dramatically in 2003, when Medicare took much of the profit out of giving the treatment by cutting down on physician reimbursement for the drugs.
Some physicians say that their patients are the ones who request overtreatment. But can they really blame the patient?
“It is the physician's responsibility to counsel the patient and even teach the patient what approaches are most appropriate. There is evidence that some physicians are able to convince patients to accept less aggressive evidence-based practices. In one of the studies, authors noted that younger American physicians were more likely to use observation according to accepted standards, and older doctors were more likely to be associated with more aggressive therapies,” according to CNN.
Many physicians also have difficulty accepting the fact that there are some cancers that will never progress. These types of cancers do not warrant the aggressive therapy that they are often prescribed. This is known as over-diagnosis.
How common is over-diagnosis? CNN reports, “It has been estimated that over-diagnosis occurs in half of all patients with prostate cancer, perhaps 30% to 40% of those with thyroid cancer, 10% to 30% of breast cancer patients and even some with screen detected lung cancer. One of the challenges of modern medicine is to develop better abilities to distinguish the cancers that need treatment from those that do not. Ironically, these abilities are relatively well-developed for certain prostate cancers and simply not used in the U.S.”
The authors of the studies stress the fact that patients need to be their own best advocate and get second and third opinions before they take on any treatment plan. “Public reporting of physicians' cancer management profiles might enable primary-care physicians and patients to make more informed decisions about selecting physicians to manage prostate cancer,” according to CNN.
Experts hope that American physicians adopt a better treatment system soon as a one size fits all treatment plan is not effective because all people have very different types of cancer. Patients with low level tumors that cannot progress should particularly not be given aggressive treatment plans.