Clinical trials - Your Doctor and You – What You Know and Might Not Know, The Money Problem, Hope Better Than Hopelessness, Eleventh in a Series

What You Know

One thing’s for sure. You know you want to live. As a transplant surgeon, John Najarian of the University of Minnesota, once said to me,

“I have never met a patient who didn’t want to live another day.”

From your research, you know clinical trials out there might yield a miracle drug. You know heretofore incurable cancers – childhood leukemia, Hodgkin’s disease, testicular malignancies, stromal tumors of the stomach, myeloid leukemia in adults and other cancers treated early and aggressively – are often cured.

You know about Lance Armstrong. You know today there are more cancer survivors than ever, 10 million of them (American Cancer Society).

What You Might Not Know

But, alas, you might not know most new drugs may are marginally effective, only occasionally curative. What you might not know is that 80 percent of oncologists are willing to try a drug if it prolongs life by two months (American Cancer Society survey). Oncologists want you to survive as long as you can, and they are willing to try any drug to prolong your survival.

These new drugs include.

• Avastin for colon, breast, .lung, and pancreatic cancers.
• Erbituz for advanced colon cancer
• Gleevec for chronic myeloid leukemia
• Herceptin for breast cancer
• Rituxan for B-cell non-Hodgkin’s lymphoma
• Tarceva for non-small cell lung caners and pancreatic cancer
• Thalomid for plasma cell myeloma

The Money Problem

These drugs may cost from $25,000 to $100,000 for a year’s treatment. Critics question the ethics of pharmaceutical companies in charging “outrageous prices.” (“Cancer Drugs Offer Hope, but Expense Worries Doctors and Patients,” New York Times, July 12, 2005).

Yet, even in the face of these criticisms, doctors and patients are reluctant to confront the pharmaceutical companies, perhaps because it is unseemly to put a value on human life. Some fear drug firms will stop research into newer more effective cancer drugs, and they hope, against all odds, the money will come from somewhere in this vast affluent nation.

Hope Better than Hopelessness

And so hope lives on that somewhere out there a cure lurks, a cure that may be just around the corner. We always have hope we will be one who wins the “battle against cancer.”

According to a New York Times piece “ The Ethics of Hope: Doctors' Delicate Balance of Keeping Hope Alive,” Meg Gaines, director of the Center for Patient Partnerships, a patient advocacy program at the University of Wisconsin, Madison, false hopelessness is worse than false hope.

"I tell people to ask the doctor, 'Have you ever known anyone with this disease who has gotten better?' If the answer is yes, just say, 'So let's quit talking about death and talk about what we can try!' "

Some patients beat the odds; others succumb even when the odds are piled in their favor. But total ignorance about the odds, she cautions, can be dangerous.
She says,

"People should know about prognosis to the extent that it's necessary to make good decisions about monitoring your health care,"

"You can't be an ostrich in the sand. When the stampeding rhinoceros is coming, you have to be able to get out of the way.”

Wrapping Up

Cancer remains a feared disease. Detected early, many cancer victims are cured. More than 50 percent of cancer patients now survive. There are now more than 10 million survivors. Although chances for cure are greater than ever, new more effective cancer drugs may cost $25.000 to $100,000 each year. Doctors who treat cancer patients will treat advanced cases with drugs if data shows these drugs will prolong live by two months or more. Cancer doctors must combine realism with hope, and if all hope evaporates, they can comfort patients by saying they will be with them until the end.