Ethics in Medicine

When Less Treatment is More

Kristen Sparrow • March 31, 2012

An article worth reading in its entirety discussing the new guidelines for breast cancer treatment. We’ve discussed breast cancer treatment a few times, for example, here and here. A few excerpts will follow. In the case of cancer, I can’t help but wonder if our language is too clumsy. Perhaps a small “cancer” would be allowed to just be if it was called “a lump of abnormal cells.” I posted about this earlier, here. The term cancer, from the word crab, (Latin?) implies that it keeps eating away. But some of these “cancers” go away on their own, or won’t cause any further damage. Incredibly difficult to change the thinking of patients or doctors at this stage of the game. It is a conversation well worth having, however. “Less is More” is the name of Dr. Redberg’s blog in Annals of Internal Medicine, we’ve discussed here, and here,

March 29, 2012, 1:23 pm

When Less Treatment Is More

Michele Constantini
The path of less, versus more, treatment has met with resistance…

“Sometimes the hardest thing for us doctors to do,” her surgeon said to me, “is to know when not to do anything.”I was reminded of the relevance of his remark for both doctors and patients when I read a study on breast cancer treatment published this month in The Journal of Clinical Oncology.
For years, the standard treatment for most women with early-stage invasive breast cancer has been to cut out the tumor and then administer radiation. But eight years ago in a major study, that approach was re-evaluated for women over age 70. It turned out that putting older women with less aggressive early cancers through the additional rigors and complications of radiation — fatigue, rash and the need to visit a radiation center daily for a month or more — had no effect on their survival rates.
A year later, the findings were incorporated into a widely accepted series of cancer treatment guidelines that recommended surgery — but rendered radiation optional — for women over 70 with more favorable early forms of breast cancer.
But in the latest study, researchers from Yale University’s School of Medicine discovered that the earlier study and resulting recommendations have had little effect on what treatments older breast cancer patients are receiving. ..
“We’ve become increasingly concerned about the overuse of screening tests or excessive treatments with little benefit,” said Dr. Cary P. Gross, associate professor of medicine at Yale and senior author of the study. “But these concerns aren’t reflected in changes in how we are caring for patients…”
Patients, too, may feel the same way and insist on proceeding with treatment. Convincing them otherwise can require lengthy discussions that many doctors don’t have the time for. “It’s almost simpler to present a ‘plan of action’ than convince a patient that doing nothing is a reasonable course,” said Dr. Kenneth B. Roberts, another one of the authors and an associate professor of therapeutic radiology at Yale.“Our system’s ability to find new treatments has far outpaced its ability to understand the limits of those treatments or to communicate with patients about the best strategies for those treatments,” Dr. Gross said. “What we need to do is step back and figure out how we can design our health system so that the right patient gets the right care at the right time, rather than all patients getting more care all the time.”

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