The idea that one might not receive any treatment at all for metastatic prostate cancer will seem bizarre to many readers of this blog — but non-treatment of advanced forms of cancer is actually not that unusual.
A new study by Small et al. has shown that, in fact, about a fifth of all the people in America diagnosed with metastatic solid tumors (like metastatic breast, lung, and prostate cancers) actually receive no radiation therapy and no other forms of systemic therapy (like chemotherapy or androgen deprivation) intended to effectively treat their cancer (as opposed to purely palliative care designed to minimize the related symptoms of that cancer).
The authors looked at data collected in the National Cancer Data Base from the years 2000 through 2008, and were able to show the following:
- 773,233 people were diagnosed with some form of AJCC Stage IV metastatic solid tumor.
- 159,284/773,233 (20.6 percent) received no anti-cancer therapy (although they may have received things like anti-pain medications for relief of their symptoms).
- 11.1 percent of men initially diagnosed with metastatic prostate cancer received no form of anti-cancer therapy (i.e., not even androgen deprivation therapy).
- As many as 24.0 percent of men and women with lung cancers received no form of anti-cancer therapy.
- Older age, black race, lack of medical insurance, and lower income were all associated with a lack of effective cancer treatment.
Now there may well be some people who elect not to have systemic treatments when diagnosed with metastatic forms of cancer (even if they can afford it). People who are older, sicker, etc., may well choose, very deliberately, to have only palliative care and to accept that any potential benefits of therapy would be small for some types of cancer. And there can be good reasons to justify such mindsets.
Of course it is also true that, in America over the past decade, large numbers of people simply have not been able to afford the costs associated with effective systemic cancer care.
Whatever one may think about the Affordable Care Act, The “New” Prostate Cancer InfoLink finds it very disturbing that the richest country on Earth has no really effective system in place to provide good quality health care to those who can least afford this (for one reason or another). Taking the personal decision to avoid things like chemotherapy because you prefer to let life take its course is one thing. Being forced to take that decision for financial or other reasons is quite another.