​Quality of life be damned, full treatment ahead, my kids have college tuition to pay

No Reduction in Aggressive Care for Advanced Cancer

One of the interesting thing I found interviewing, deposing, and speaking with doctors in my litigation practice is that they always prioritize quality of life for themselves and their families. But their patients choose the opposite. Since then ample research has confirmed this. 

More after the break.

"More data are needed to show that this practice leads to "misery," said an expert not involved with the study.

"The responsibility is with physicians to do a better job clarifying the goals of care with their patients and further understanding the patient's goals and priorities," said lead study author Ronald Chen, MD, from the University of North Carolina at Chapel Hill.

"Toward the very end of life, this is especially important because continued aggressive treatment would likely cause side effects but be unlikely to significantly extend a patient's life. This type of discussion can help reduce the overuse of aggressive care and, frankly, we probably have to have the discussion repeatedly because as the cancer progresses and the end of life gets closer, these goals may change," he told Medscape Medical News."

Is it possible the "misery" expert has never followed a patient to end of life with diseases like cancer, or mesothelioma? This comes across as nothing more than, "Shut up, we're making money here!"

And, yes, I know how hard this is. We were the primary care for mother-in-law right up till her death, which happened in our home, where it should have happened. This is difficult stuff, but doctors need to make it clear that destroying quality of life at the end of life is a terrible idea. 

This quote shocked me, and little actually shocks me anymore. 

"'In addition, about 25% to 30% of patients received chemotherapy in the last 30 days of life. Radiation therapy was used the least of all the categories we looked at — about 15% to 20% received that. And 25% to 30% of patients received invasive procedures," he reported."

Chemotherapy? Radiation? Invasive treatments? At end of life? This is very close to malpractice. 

"'We have a desire as physicians to help our patients when a cancer progresses by offering them treatments, and we're not very good at realizing when a patient is at the end of life. I think this combination is probably the most likely reason for the overuse of aggressive care," he said."

That places a fine doctor spin on that ball. I am not sure I would be so magnanimous. I agree that doctors do want to do everything they can for their patients, but as the game gets late, they should probably consult in second opinion as to the patients end-of-life status. Not an opinion paid for by the patient. 

"But Holly G. Prigerson, PhD, director of the Cornell Center for Research in End of Life Care in New York City, had stronger words for what she calls "this pernicious pattern of care.'"

Agreed.