Too Good to Be True? Let’s Check What’s Really Possible!

May 30, 2010 - 12:09 pm email to a friend

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Dr West

GRACE member DonnaS raised a very common and appropriate question (see thread here) about why we don’t more routinely recommend procedures like radiation or radiofrequency ablation, or surgery for people with metastatic cancer, especially if there are advertisements from various centers extolling the virtues of their new techniques for helping people potentially achieve better results than ever thought possible, possibly even a cure when others had said this wasn’t possible.

I’ll admit that these advertisements have been a real pet peeve of mine because I think they take advantage of people’s need for hope and potential desperation. If your oncologist tells you that your metastatic lung cancer isn’t curable and a nearby cancer center runs a newspaper advertisement that describes a testimonial of a patient who seemingly defied the odds by pursuing their institution’s cutting edge technology, shouldn’t this lead you to question your oncologist, pick up the phone, and try to sign up?

People shouldn’t blindly accept conventional wisdom, and in fact there are certainly people with advanced lung cancer who have done remarkably well and even appear to be cured years after diagnosis (described in part by the concept of the “precocious metastasis” (summarized, and discussed in podcast). In fact, there are even studies that are beginning to study the question of whether it is feasible to treat people with minimal residual viable disease with curative intent.

It’s not that individual cases don’t merit very personalized decision-making, and most of us who work in cancer care have come to appreciate that almost anything is possible. The problem is that mass-marketing these possibilities is misleading, and I suspect a mechanism to maximize profit by extending an expensive intervention to a market of both people who are reasonable as well as much less appropriate candidates for these approaches (although they will certainly be limited to people who can pay for them, either themselves or through insurance — they aren’t being done as charity care).

All of us would love to learn about successes for the people who defy the odds and highlight what is possible. However, we don’t want to be manipulated by institutions or companies that are duping people into pursuing futile treatments. So I’m going to request that people please add in the comments here, or in an e-mail to me at west@cancergrace.org, any internet links or details of contact information for places that are making claims that don’t seem to jibe with what you’re hearing here about standards of care and might seem to be improbably optimistic, if not quite too good to be true.

Whether it’s a radiation approach, radiofrequency ablation, new surgery, investigational agent, or novel test that promises things that we haven’t extolled here, I’d love to chase down as much truth as I can find from the sources. I’ll be eager to relate any information I can get about the the success stories — and we can all probably learn from what makes them success stories — as well as the possible sobering reality that many of these advertisements are actually delivering false promises.

Let’s shine some light here and see what we find. I’ve had enough of patients being preyed upon based on desperation, but if I’m wrong, people here should learn of the successes of the places that are setting themselves apart.

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