The Problem with Miracle Cancer Cures
Back in the late seventies, my best friend’s Mom was dying from a very aggressive cancer and the doctors sent her home to die. My friend helped her mortgage the house so she could go to Mexico and receive a cure for her cancer. That was laetrile, a compound found in apricot seeds but with a very high cyanide content. For $30,000, a tremendous amount of money at that time, she simply died even faster.
In the same era I had an aunt who came down with ovarian cancer. My uncle, her husband was a millionaire and took her all over the world seeing doctor after doctor looking for a cure. But once again, the scammers took the money and ran with their lies about cancer cures. My aunt died very young and my uncle was devastated.
For some reason we accepted these snake salesman who promised cures and in the end we felt that we had learned our lesson. However, today the worst scammers are actually the pharmaceutical manufacturers with their very latest cancer cures at horrendous prices.
It used to be that patients with advanced cancer were put into palliative care which decreased their pain, improved their comfort and even, in some cases, prolonged their lives for a few months. But now the drug industry has thrown a wrench into the way we treat patients with advanced cancer.
The reason is a new generation of cancer treatments that have become available in recent years. Some, called immunotherapy, harness the patient’s own immune system to battle a tumour. Others, known as targeted therapies, block certain molecules that cancers depend on to grown and spread. The medical literature—usually cautious when it comes to cancer, in light of many overhyped treatments in the past—now fairly gushes with terms likes “revolutionary” and “cure.” In this case, the hype feels mostly justified.
Much has been written about the promise of these treatments, as well as their staggering costs—many cost several hundred thousand dollars a year and are not covered by OHIP because they are too new. But what strikes me the most about them is that by blurring the line between cure and comfort—and between hope and hopelessness—they have disrupted the fragile equilibrium that health professionals take for granted.
Oncologists are seeing patients whose cases they once would have pronounced hopeless now look at these new drugs and believe they can snatch stage 4 cancer patients from death’s door. A person I knew had bone marrow cancer and when treated with a new immunotherapy drug was actually cured of her myeloma. This was wonderful news for her but the reality is for most people the drugs do not work and they die in pain.
+++ sophisticated, scientifically tested drugs are all advertised on the American evening news networks. According to Kantar Media, pharmaceutical companies spent 6.1 billion dollars on these ads. (This type of advertising is against the law in Canada but all of us watch American cable.) The wonderful ads tell us that the drug Keytruda will help cure lung cancer patients but they don’t tell you it will cost $13,500 monthly and that is US dollars. The drug Neulasta is supposed to reduce the risk of infections after chemotherapy but they do not tell you it cost $6200 for each injection. Bristol Myers Squibb has ads for its lung cancer drug Optivo but once again fail to disclose the $13,680 monthly cost. And finally we have Ibrance, a treatment for breast cancer that may spread to other parts of the body. Do you want your cancer to spread? No problem; just come up with $10,000 a month for the rest of what may remain of your life. In Canada, all the provinces have different formularies so what may be covered in one province may not be covered in another and if the drug is new, then for sure you will have to pay. The good or bad news, depending upon how you look at it is that most of these drugs do not work so you may only be paying these exorbitant prices for a few months before your death. In my mind, the pharmaceutical companies are no different from the cancer-cure quacks on the internet except for the fact that they have a much larger advertising budget.
A recent analysis estimated that about 15 per cent of patients with advanced cancer might benefit from immunotherapy—and it’s all but impossible to determine which patients will be the lucky ones. Just last month, a study of lung cancer patients demonstrated the overall benefits of combining immunotherapy with traditional chemotherapy. But here too, the researchers noted that most patients will not respond to the new treatments, and it is not yet possible to predict who will benefit. In some cases, the side-effects are terrible—different from those of chemotherapy but often just as bad.
With patients and family primed to hold onto every reed of hope, even a small chance of a cure or prolonged remission will cause the majority to stick with their pugilistic approach to cancer. Eventually cancer patients are forced to choose between comfort and cure. This means that as long as these new drugs keep coming out most will forgo palliative care. Then, with only a few days left in their life, after needlessly suffering for weeks or months will finally choose hospice.
What should be done? First, it turns out that many patients benefit from palliative approaches even as they continue aggressive treatment for their cancer. In 2016 The American Society of Clinical Oncology recommended that concurrent care—palliative and active cancer care be delivered at the same time—be made available to patients with advanced cancer. Rules that force patients to choose one approach or another, particularly those that tie insurance coverage of palliative care or hospice to stopping active cancer treatments, should be scrapped.
Second, doctors need more training in how to have these hard conversations with patients in light of the new cancer treatments. They should be much more aware of the realistic prognosis of these new drugs and explain the harms and side-effects to the patients. Unfortunately, the pharmaceutical industry highly promotes the upside of the new treatments and gives the physicians much more hope than they should have. They would never tell the oncologist that in spite of this new radical approach to cancer, 85 per cent of their patients will not respond to the drug and die a horrific death.
Finally, through the federal Cancer Moonshot program, the US government is spending millions of dollars to study immunotherapy and other emerging treatments for cancer. The sooner we find out which patients will—and just as important, won’t benefit from these approaches, the better.
Sadly, for some patients, a cure will prove elusive. As we continue to chase progress in cancer, let’s be sure that we don’t rob dying patients of a smaller, more subtle miracle: a death with dignity and grace, relatively free from pain and discomfort. [print_link]