Americans are treated and overtreated to death
Marilynn Marchione | 6/29/2010, 7:27 p.m.
Then she called Dr. R. Sean Morrison, president of the American Academy of Hospice and Palliative Medicine and a doctor at Mount Sinai School of Medicine in New York.
“Nobody had really sat down with them about what his choices are and what the options were,” said Morrison, who became his doctor.
About a year later, Felker withdrew his own feeding tube, and “it enabled us to go out and have a wonderful evening at a jazz club two nights before he died” in July 2008, Sheehy said.
Doctors can’t predict how soon a patient will die, but they usually know when an illness has become incurable. Even then, many of them practice “exhaustion medicine” — treating until there are no more options left to try, said Dr. Martha Twaddle, chief medical officer of Midwest Palliative and Hospice Care Center in suburban Chicago.
A stunning number of cancer patients get aggressive care in the last days of their lives, she noted. One large study of Medicare records found that nearly 12 percent of cancer patients who died in 1999 received chemo in the last two weeks of life, up from nearly 10 percent in 1993.
Guidelines from an alliance of leading cancer centers say patients whose cancer has spread should stop getting anti-cancer medicine if sequential attempts with three different drugs fail to shrink their tumors. Yet according to IntrinsiQ, a cancer data analysis company, almost 20 percent of patients with colorectal cancer that has spread are on at least their fourth chemotherapy drug. The same goes for roughly 12 percent of patients with metastatic breast cancer, and for 12 percent of those with lung cancer. The analysis is based on more than 60,000 cancer patients.
Often, over-treating fatal illnesses happens because patients don’t want to give up.
Saideh Browne said her mother, Khadija Akmal-Lamb, wanted to fight her advanced ovarian cancer even after learning it had spread to her liver. The 55-year-old Kansas City, Mo., woman had chemo until two weeks before she died last August.
“She kept throwing up, she couldn’t go to the bathroom,” and her body ached, Browne said. The doctors urged hospice care and said, “Your mom was stubborn,” Browne recalled. “She wanted her chemo and she wanted to live.”
Browne, who lives in New York, formed a women’s cancer foundation in her mother’s honor. She said she would encourage dying cancer patients to choose comfort care over needless medicine that prolongs suffering.
It’s easier said than done.
The American way is “never giving up, hoping for a miracle,” said Dr. Porter Storey, a former hospice medical director who is executive vice president of the hospice group that Morrison heads.
“We use sports metaphors and war metaphors all the time. We talk about never giving up and it’s not over till the fat lady sings ... glorifying people who fought to their very last breath,” when instead we should be helping them accept death as an inevitable part of life, he said.
This is especially true when deciding whether to try one of the newer, extremely expensive cancer drugs such as Avastin, Erbitux and Tarceva. Some are touted as “improving survival by 30 or 50 percent” when that actually might mean living three weeks or months longer instead of two.