11 percent of men in America with metastatic prostate cancer get no anti-cancer therapy

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.

4 Responses

  1. Well said.

  2. It makes you think about it. I’ve had an RP, hormone therapy, and radiation. What else is there? More hormones, which make you feel awful.

    Till you’re there, you don’t know what you’ll do. Of course they say chemo helps with the pain. Think I’d prefer pain medicines than be sick and hurt. This is strictly my opinion.

  3. I often see comments like this, but based on my own personal knowledge of how the hospital system works, I find them hard to believe. I do volunteer work in a local Catholic hospital, where they do everything possible to treat everyone (for life-threatening conditions) regardless of ability to pay. There is an army of volunteers who help the hospital to operate economically. Large amounts of money are donated each year to help pay for care for those who can’t afford it. There is one group of volunteers that specializes in locating funding for patients (Medicaid, or one of the many private charities associated with the hospital). And finally, there are some who leave the hospital with large bills, which the hospital knows can never be collected. As long as some effort is made to send some small amount in the bill each month, the hospital will not turn it over to a collection agency. My wife has worked (as part of her training) at our inner city hospital, which is charged with treating everyone, regardless of ability to pay.

    I think there is an assumption being made that people weren’t treated because they couldn’t afford it. It would be more instructive to follow up with a sample of those not treated and get the actual reason they weren’t treated. If it was because they couldn’t afford it, more detailed information would still be needed, such as: How did they attempt to obtain treatment? Which hospitals did they visit? Did anyone help them determine eligibility for Medicaid or other help? Did any hospitals turn them away?

    I can imagine lower income folks, due to a whole host of issues such as transportation difficulties, lack of caring family support, lack of education (such as, can’t read), lack of regular doctor visits, etc., might often be diagnosed later than others.

    But, I have some trouble with the assertion: “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.” There are systems currently in place to treat these folks … are there substantial numbers of well documented cases where people tried to get treatment and were refused?

  4. Dear Dennis:

    There are indeed excellent and well-organized non-profit institutions all over America that make every effort to offer the best care possible to anyone who walks through the door. No one is questioning that.

    However, there are also many, many well documented cases of refusal of care; refusal of further care until bills are paid; you name it. Your experience may be very positive because of the mindset of the community you live in. Other places can be very different.

    I am making no “value judgments” about why a specific patient with metastatic cancer didn’t get care at a specific institution, but for many people, if they have to travel 20 miles (sometimes with great difficulty) to get a diagnosis only to be told that they can’t be given care, they may well just go back home and make little to no further effort to seek that care elsewhere.

    As a Board member of two different cancer not-for-profit organizations and of another not-for-profit that deals with patients with rare disorders, I can assure you that getting anything approaching high-quality care can be a major struggle if you have financial challenges or even a rare form of disease that no one can diagnose accurately.

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