Death Panels Add Life

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1. [...] cancer patients, those patients die no less, and maybe more. That fits with cancer patients living longer when they go to hospice and get no cancer treatment and with randomized trials of cancer screening [...]

   By Overcoming Bias : Beware Cancer Med May 23, 2011 at 4:22 pm

9 Comments

1. blink

   August 31, 2010 at 9:36 pm | Reply

   Median survival does not seem like the right measure here since 30% survived through the entire study period. What if the aggressive treatment is more like a gamble: if you are one of the 7/10, it will shorten your life, but if you are one of the 3/10, you actually beat the cancer and live many more years. I don’t think the data in the NYT article and excerpt here supports the conclusion.

   • Jess Riedel

     September 1, 2010 at 10:48 am | Reply

     Exactly. This interpretation is consistent with my vague impression that many cancer treatments (e.g. chemo) are very taxing on the body and, when not successful, leave the body in significantly worse shape.

     • Dan Weber

       September 1, 2010 at 12:11 pm |

       Even when successful, they can leave you with, say, no bladder control. You get another year of life but you spend it wearing a diaper.

       This is why quality-of-life measures are an important part of the discussion.

2. Joseph Hertzlinger

   August 31, 2010 at 11:30 pm | Reply

   Let’s see … A comparison between a group receiving A and a group receiving A+B shows A+B is better. This is sold as showing the benefits of B instead of A. Run that by me again?

   • Meng Bomin

     September 1, 2010 at 10:48 am | Reply

     The key lines are as such:

     Even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and many more left orders that they not be resuscitated in a crisis, they typically lived almost three months longer than the group getting standard care, who lived a median of nine months. …

   • David C

     September 1, 2010 at 1:41 pm | Reply

     It’s more like a comparison between a group receiving A+C and a group receiving A+B which found that A+B is better. This proves that B is greater than C, but not necessarily that B is positive. The researchers assume C is positive, and so conclude B is also positive.

3. Floccina

   September 1, 2010 at 9:25 am | Reply

   Should we avoid optimistic Doctors and and opt for the guys who tell us not much can be done?

   • Lyle

     September 2, 2010 at 1:31 am | Reply

     “not much can be done” – Um, that’s not what palliative care is about. If you want to frame it in terms like that, maybe “opt for including realists in your health care team along with interventionalists,” but the media (and this thread’s) tendency to focus on length of survival is misguided regardless. Quality of life was better and there was less depression – these were the main outcome measures. The length of life data is solid for this particular patient group (this is the New England Journal, after all), but I wouldn’t count on it as a consistently reproducible outcome measure for involvement of palliative care. Most interesting, though. [and don't get me started on whatever vague link some people are making between palliative care professionals and 'death panels,' but if that's a connection that's being formed in some people's minds, then Ms. Palin may have done more damage with her popularization of that phrase than with anything else she may achieve. Okay, you did get me started after all:)]

4. winter boots

   September 2, 2010 at 4:53 am | Reply

   We should choose how to deal with mental problems?