I certainly would want to know this in advance. What about you?
2023-01-31, by Peter C Gøtzsche, Institute for Scientific Freedom. Emphasis in (only) red and yellow added.
If you get cancer, one of the most important questions is to decide if you should accept or decline chemotherapy. By far most patients accept chemotherapy, likely because they think that if it wasn’t worthwhile, it wouldn’t be offered.
This is a mistake.
Chemotherapy is rarely worthwhile
We hear a lot about progress against cancer. This narrative increases donations to cancer charities and benefits doctors who do research on cancer therapies, and it affects not only the public but the doctors themselves. Their belief in the effectiveness of chemotherapy is so strong that virtually every cancer patient is offered chemotherapy, even in the last few weeks before they die.1
The truth is that, with a few exceptions, little progress has been made the last 70 years when it comes to chemotherapy.2,3
A 2004 review of the randomised trials showed that the overall contribution of curative and adjuvant cytotoxic chemotherapy to five-year survival of adult cancer patients in USA and Australia was only 2%. In the vast majority of cancer cases, over 90%, the effect of chemotherapy was marginal, corresponding to a life extension of only three months. And new drugs for solid cancers approved by the European Medicines Agency increased survival by only one month compared to other regimes.4
But when you analyse specific types of cancers, there are a few where chemotherapy has significant benefits. The contribution to five-year survival was 39% for testicular cancer, 39% for Hodgkin’s disease, 12% for cervical cancer, 11% for lymphoma, and 9% for ovarian cancer.
Would doctors accept chemotherapy for themselves?
In Denmark, two journalists asked two prominent doctors what they would do if they got cancer and were offered chemotherapy that gave them a poor chance of surviving. Both would refuse the chemotherapy and one explained he would prefer to enjoy the life he had left.5
Such reasonable ideas have powerful enemies in interest groups. The chair of the Danish Cancer Society, Frede Olesen, reprimanded the doctors, saying they harmed the trust between patients and doctors.
They didn’t, in my opinion. They gave sound and honest advice to the public, which is what the public needs. The patients should enjoy the same privileges as health professionals, and few oncologists and nurses are willing to accept the chemotherapy their patients endure for minimal benefit. In elderly patients, aggressive treatment is even more misplaced. What is most important to them is to maintain their independence and dignity, not to gain a few extra weeks of doubtful quality. Ending our lives spending time with our loved ones is far more attractive than being pestered by the toxic effects of chemotherapy, with frequent hospital admissions, which increase the risk that we will die in a hospital bed rather than at home.
I have often witnessed the horrible consequences for the patients, their friends and relatives of fighting till the bitter end. I have also met with people who have been ruthlessly exploited by charlatans, and here is an example...
...Screening for a cancer is useless if it does not make people live longer. When the patients do not live longer, but live longer with the knowledge that they have cancer because the clock started earlier, the “early detection” of cancer is unequivocally harmful. There are many such offers of useless screenings on the private market.
Our spineless drug regulators
...Drug regulators approve new cancer drugs without having a clue whether they are better or worse than those we already have, or even just better than doing nothing.16,17 This broken system has resulted in huge expenditures on cancer drugs with certain toxicity but uncertain benefit.
The authors of a 2019 review reported that approximately one-third of cancer drugs are approved by the US Food and Drug Administration based on response rate, which is the percentage of patients whose tumours shrink beyond an arbitrary threshold, typically assessed in a single-arm study.18 Thus, some new cancer drugs are approved without any evidence from a randomised trial that they work.
Even when randomised trials have been performed and marginal effects have been found, these trivial differences may disappear when the drugs are used in real life on patients suffering from co-morbidities.17
I agree with my Danish colleagues.5 Apart from testicular cancer and lymphomas, I cannot imagine any cancer that would make me accept chemotherapy should I get cancer.
Obituaries often say: “He lost the battle against cancer.” But why the war rhetoric? Why not say something positive, like “He had a good life,” as most of the life was not about fighting cancer?
And should we fight at all? We should not fight a battle we have already lost, and it will surprise most people, doctors included, that, unfortunately, this is the case for most cancer patients.
WIND: trust your doctor? Seems like one more brick in the wall of distrust: is the medical profession (as a whole) about patient benefit, or 99% about follow the money? I will exclude some obvious areas from that (eg trauma and certain curable conditions).
Is chemotherapy largely a profit center for the institution, and a pain-and-suffering proposition for the patient? The consideration of those questions is an especially acute example of ethics in medicine, yet it is rarely if ever considered. Which helps you understand the oxymoron of medical ethics.
Having escaped death twice in bike crashes (by some miracle), and the past few years of impaired function (COVID => thyroid disease and EBV), I’ve given a lot of thought to quality of life, healthspan vs lifepan, and what I would do were I to get cancer or something nasty. I find it curious how feel people are wildly in fear of their own death, which I’ve lost. I fear only suffering and so the article above is particularly interesting to me. Of course, I would assess the particulars if the time comes.