Death Panels Add Life

In the three-year study, 151 patients with fast-growing lung cancer at Massachusetts General, one of the nation’s top hospitals, were randomly assigned to get either oncology [= anti-cancer] treatment alone or oncology treatment with palliative care — pain relief and other measures intended to improve a patient’s quality of life. They were followed until the end of 2009, by which time about 70 percent were dead. …

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. …

During the debate over President Obama’s 2009 health care bill, provisions to have Medicare and insurers pay for optional consultations with doctors on palliative and hospice care led to rumors … that the bill empowered “death panels” that would “euthanize” elderly Americans. Legislators eventually removed the provisions. …

Palliative care experts now want to study patients with other cancers, heart disease, stroke, dementia and emphysema. But … the pharmaceutical industry, has little incentive to study palliative care. (more)

From the paper itself:

Despite receiving less aggressive end-of-life care, patients in the palliative care group had significantly longer survival than those in the standard care group (median survival, 11.6 vs. 8.9 months; P = 0.02). … Any chemotherapy within 30 days of death … [Standard Care N (%)] 21/50 (42.0%) [Early Palliative] 13/40 (32.5%).

Note that by cleverly having their experiment combine patients informally getting less new hi-tech medicine with patients formally getting more “palliative” old lo-tech medicine, docs can frame this result as supporting giving people “more” medicine.  HT Carl Shulman.

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  • blink

    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

      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

        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.

  • http://hertzlinger.blogspot.com Joseph Hertzlinger

    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?

    • http://mengbomin.wordpress.com/ Meng Bomin

      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

      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.

  • http://un-thought.blogspot.com/ Floccina

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

    • Lyle

      “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:)]

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