"Considering Longer Chemotherapy"- NYTimes

[TheTippingPoint]

http://www.nytimes.com/2009/07/21/he...canc.html?8dpc

The article quotes Dr. Einhorn at about the midway point.

[ukboyuk]

Seems like the drug companies are trying to push people's emotional buttons despite their being little or no evidence that this "maintenance therapy" works.

But if they can get it to work and with less side effects, it reminds me of the treatment that HIV patients get to stop them progressing to AIDS.

It will cost a hell of a lot though. Who's gonna pay for it in the long term? Higher premiums/taxes for everyone? Or will only the rich be able to afford it?

[Fed]

Seems like the drug companies are trying to push people's emotional buttons despite their being little or no evidence that this "maintenance therapy" works.

Drug companies aside, I do think that maintenance therapy does have clinical value. While on the surface it would seem that pharma is just pushing more drugs, there article points out that there is some evidence that suggests such maintenance regimens work. In fact, we have two very clear examples of that here in the forum: milwaukeejoe and TC Destroyer. Both underwent HDC, and even though both showed NED by displaying normal HCG levels, a maintenance regimen of oral VP-16 ensued.

[ukboyuk]

When you put it in those terms, it seems that short term therapy in terms of "over-treating" "just in case" or "to make sure" is nothing new. Adjuvant therapy, although a sole treatment, is similar too.

These trials look like for treatment over a year or so. It will be interesting to see the value of treatment over a much longer period.

The conundrum of funding still needs to be solved though. If successful maintenance therapies add a few percentage points onto survival rates but cause a massive increased cost, I wonder how these are going to be paid for. For example, Herceptin has proved controversial both in the US, Canada and UK with some insurance companies or health authorities refusing to pay for it.

[NYC Russ]

Interesting article, thanks for posting it.

What's most sickening about it though are some of the comments people made in reply. I'm flabbergasted that (some members) of today's society not only think the way they do, but have no qualms sharing their ridiculous opinions.

[ukboyuk]

I had missed the replies, here they are:

http://community.nytimes.com/comments/www.nytimes.com/2009/07/21/health/21canc.html

I guess maybe unless you have had cancer or someone very close to you has, you can never understand it the way we do. By the same token, maybe cancer patients are too involved to be rational.

[NYC Russ]

I had missed the replies, here they are:

http://community.nytimes.com/comments/www.nytimes.com/2009/07/21/health/21canc.html

I guess maybe unless you have had cancer or someone very close to you has, you can never understand it the way we do. By the same token, maybe cancer patients are too involved to be rational.

So how much is your life worth (in Pounds or USD)? (And think carefully before you answer, I have a lot of disposable income )

[ukboyuk]

I would say that life is priceless. But saving lives costs money and a price has to be put on it. I'm glad I don't have to make the decisions.

[Davepet]

Certainly life is priceless, assuming a reasonable degree of health, & the physical ability to do wha one wishes to do on a daily basis.

I was dismayed by the cost of some of these treatments vs the amount of life they gave the patients. As an example:

But in the trial, some patients got Alimta immediately after completing the initial, or first-line, chemotherapy. They lived a median of 13.4 months, significantly longer than the 10.6 months for those who got a placebo. And patients with the type of tumor for which Alimta works best lived a median of 15.5 months with maintenance therapy.

So at most we are extending life by 4.9 months

Alimta, also known as pemetrexed, costs about $4,000 per infusion given once every three weeks. Based on data from Lilly’s trials, patients getting the drug as maintenance therapy would receive an average of three more infusions than those getting the drug as second-line therapy.

So US $12K for 4.9 months . Might be worth it if you can get out there & take that cruise you always wanted or otherwise cross most everything off your bucket list, but I suspect those people are pretty much unable to live anything close to a normal life for those 4.9 months.

Now if the patient is picking up the tab out of pocket, nobody has the right to even question if the cost outweigh the benefits. But since most patients have either private or government insurance picking up the tab, we *all* pay for these treatments, in either higher premiums or higher taxes.

Can we as a society, afford to extend life by 4.9 months at a cost of $12,000? Especially if the quality of that life is questionable at best? Is it even moral to use extraordinary measures to extend life when there is no ability to do more with that life than lie in a bed & the near term outcome is certain?

I struggle with these questions myself, but I really think our technology is outstripping our ability to pay for it as a society or understand the implications from a moral standpoint.

Dave