From Yale News, February 27, 2012:
Treatment is not always warranted for older men with prostate cancer
and a short life expectancy, Yale School of Medicine researchers report
in the Feb. 27 Archives of Internal Medicine.
“Treatment can do more harm than good in some instances,” said senior author on the study Dr. Cary Gross,
associate professor of internal medicine at Yale School of Medicine.
“Among men who are older and have less aggressive forms of prostate
cancer, their cancer is unlikely to progress or cause them harm in their
remaining years.”
Gross and his team analyzed nine years of
Medicare data and found that over the past decade, there has been a
trend towards higher use of curative treatment for prostate cancer among
men with certain types of tumors and a short life expectancy. The study
included 39,270 patients between the ages of 67 and older.
These
results suggest that cancer treatment was increasingly aggressive in
patients who had the lowest likelihood of seeing clinical benefits,
Gross said, noting that while not treating potentially fatal cancer can
reflect poor-quality care, aggressively managing disease that is
unlikely to progress puts patients at risk for complications and
increases costs without medical benefits.
“We found that the
percentage of men who received treatment for their prostate cancer
treatments increased over time from 61.2% to 67.6% from 1998 through
2007,” said Gross, who is a member of Yale Cancer Center. “However, we
were surprised to find that the biggest increase was among men with
moderate-risk prostate cancer who had the shortest life expectancy. On
the other hand, cancer treatment decreased among men with low-risk
tumors and longer life expectancy.”
Treating patients with shorter
life expectancy may add costs or complications without contributing to
quality of life, he said. The National Comprehensive Cancer Network
practice guidelines in oncology recommend actively monitoring patients
as an alternative to medication for patients with less aggressive tumor
types and shorter life expectancies.
Gross said that the use of
cancer therapies should be guided by clinical evidence and patient
preferences. “Future work should explore how better to incorporate both
cancer characteristics and patient life expectancy into decision
making,” said Gross.
Other authors on the study included Ann c.
Raldow, M.D., Carolyn J. Presley, M.D., James B. Yu, M.D., Richa Sharma,
Pamela R. Soulos, Jessica B. Long, and Danil V. Makarov, M.D.
The National Cancer Institute and the James G. Hirsch Medical Student Research Fellowship funded the study.
Citation: Arch. Inter. Med. Vol. 172, No. 4 (February 27, 2012)
3 comments:
Another benefit to alternative cancer treatment is location. Every year, there are more and more doctors practicing alternative medicine. As a result, people can find treatment in places closer to home, with no need to travel to the US, Mexico, or Europe for treatment.
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