Cancer Care: A Microcosm of the Problems Facing All of Health Care
Authors: Jennifer Fisher Wilson
Journal: Annals of Internal Medicine (2009)

Current Clinical Issues21 April 2009Cancer Care: A Microcosm of the Problems Facing All of Health CareJennifer Fisher WilsonJennifer Fisher WilsonAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-8-200904210-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail When is enough treatment really enough? This question often follows physicians in all areas of medicine and their patients throughout the course of treatment. The dilemma can be particularly difficult for oncologists for whom, giving an accurate prognosis is difficult. They tend to feel optimistic about a patient's chances of benefiting from treatment and ambivalent about dashing the hopes of patients by giving them pessimistic feedback. As a result, oncologists usually prefer to talk about the goals of care with patients rather than about whether or how likely they are to die of their disease, about how long they have ...References1. Matsuyama R, Reddy S, Smith TJ. Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer. J Clin Oncol. 2006;24:3490-6. [PMID: 16849766] CrossrefMedlineGoogle Scholar2. Emanuel EJ, Young-Xu Y, Levinsky NG, Gazelle G, Saynina O, Ash AS. Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med. 2003;138:639-43. [PMID: 12693886] LinkGoogle Scholar3. Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22:315-21. [PMID: 14722041] CrossrefMedlineGoogle Scholar4. Schwartz LM, Woloshin S, Welch HG. Using a drug facts box to communicate drug benefits and harms. Two randomized trials. Ann Intern Med. 2009;150:16-27. LinkGoogle Scholar5. Avorn J, Shrank WH. Communicating drug benefits and risks effectively: there must be a better way. Ann Intern Med. 2009;150:563-4. LinkGoogle Scholar6. Pollak KI, Arnold RM, Jeffreys AS, Alexander SC, Olsen MK, Abernethy AP, et al. Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol. 2007;25:5748-52. [PMID: 18089870] CrossrefMedlineGoogle Scholar7. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300:1665-73. [PMID: 18840840] CrossrefMedlineGoogle Scholar8. Miksad RA, Schnipper L, Goldstein M. Does a statistically significant survival benefit of erlotinib plus gemcitabine for advanced pancreatic cancer translate into clinical significance and value? [Letter]. J Clin Oncol. 2007;25:4506-7; author reply 4508. [PMID: 17906218] Google Scholar9. Nadler E, Eckert B, Neumann PJ. Do oncologists believe new cancer drugs offer good value? Oncologist. 2006;11:90-5. [PMID: 16476830] CrossrefMedlineGoogle Scholar10. Medicare Payment Advisory Commission. Chapter 9: Medicare payments for outpatient drugs under Part B. In: Report to the Congress: Variation and Innovation in Medicare. June 2003. Accessed at www.medpac.gov/publications/congressional_reports/June03_Ch9.pdf on 17 March 2009. Google Scholar11. Schrag D, Hanger M. Medical oncologists' views on communicating with patients about chemotherapy costs: a pilot survey. J Clin Oncol. 2007;25:233-7. [PMID: 17210946] CrossrefMedlineGoogle Scholar12. Meropol NJ, Schulman KA. Cost of cancer care: issues and implications. J Clin Oncol. 2007;25:180-6. [PMID: 17210937] CrossrefMedlineGoogle Scholar13. Oglesby P. The Caring Physician: The Life of Dr. Francis W. Peabody. Cambridge: Harvard Univ Pr; 1991. Google Scholar Author, Article, and Disclosure InformationAuthors: Jennifer Fisher WilsonDisclosures: None disclosed.E-mail:jenwilson@acponline.org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byContribution of extended family history in assessment of risk for breast and colon cancerWhat Adult Cancer Care Can Learn From PediatricsOut-of-Pocket Expenses and Treatment Choice for Men With Prostate CancerEditorial: The case for a comparative, value-based alternative to the patient-centered outcomes research model for comparative effectiveness researchCancer Treatment in South Africa: A Narrative Literature ReviewMedical Management of Patients With Brain TumorsImplications of comparative effectiveness research for radiation oncologyIs Oncology a Microcosm of Our Health Systems Ills? 21 April 2009Volume 150, Issue 8Page: 573-576KeywordsCancer chemotherapyCancer treatmentChemotherapyDecision makingDrugsHematology and oncologyMotivationPalliative carePatientsQuality adjusted life years ePublished: 21 April 2009 Issue Published: 21 April 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...