Thoughts on Cancer Treatment Centers
Thirty years ago when I was in Med School I clearly recall a one-hour lecture that was, in effect, “Care and feeding of the Cancer Survivor.” It was mostly about the immediate aftermath of cancer treatments – radiation burns, psyche scars, whatnot. There was no other time spent on that topic – and the reason was a simple one – we didn’t have that many cancer survivors. All cause cancers (except skin cancers) had about an 80 % five-year mortality. Now it’s closer to 20 %. Cancer therapy has leaped and bounded in the three decades and now post cancer care is almost a specialty to itself. Neuropathies, post-chemo complications, and secondary cancers are all part of the aftercare, but so are mundane things like heart disease prevention, other cancer screenings, incontinence and impotence and reconstructions and all of these issues are quite simply wonderful problems to have – considering the alternative.
The flip in survival ratio comes from a lot of sources and people can argue the details, but they are a combination of earlier detection, more advanced chemotherapeutic medications, better targeted therapies (either surgical or radiation or both). I freely admit that the driving force behind these advances are cancer treatment centers. They have been the single most important factor in gathering enough patients with a cancer type for more rapid and effective drug studies, and their multiple specialty approach brings treatment teams with oncologists, physicists, radiation oncologists, social workers, stoma nurses – all in a team approach. It’s a wonder to see their success rates, and a terror to see 20 people walking down a hospital hallway rounding on patients. They look like the Peanuts Gang attacking a Christmas Tree.
Now I gave credit to what is behind this dramatic improvement in Cancer Survival – the Cancer Treatment Centers. Now, what is behind those Cancer Treatment Centers? Money. Gobs and Gobs. Pharma has been able to fund by charging unfathomable rates for meds – sometimes tens of thousands of dollars a dose, sometimes even more. We who are old remember fondly the Six Million Dollar Man. Now look at a double hip replacement, three-vessel bypass, and survivor of cancer and you could easily be looking at someone worth twice that, and far less likely to be able to jump over a building.
I am not going to jump yet again into the outrage that is pharma. I am well-documented on how extreme this problem is. I will mention three cancer treatment centers – and likely surprise some with my absolute pure hatred of one.
The first to discuss are the Cancer Treatment Centers of America. This place harkens back to a Placebo Journal submission I did – how to get the best heart failure outcomes for your clinic. Put your clinic on top of a hill, parking lot at the base, and no elevators or escalators. All your heart failure patients are great and wonderful – just don’t check the ones that tried to see you and got way too short of breath and left. So if you are healthy enough to travel to Tulsa or Chicago, you have already self-selected for pretty good survival odds – and they do boast wonderful survival odds for their patients.
The second center is the Sloan Kettering Cancer Center. They are extremely used to seeing the word “second” next to their name. Since the big bang they have been second best in the nation and in the world in treating cancer. They have long held that the first and best and most wonderful, MD Anderson Cancer Center, has cheated consistently and systematically to skew the numbers. Sloan Kettering is an excellent center for cancer treatment, and seems to be forever stuck on second. So lets now talk about number one.
MD Anderson Cancer Center has a mothership in Galveston Texas but it has metastasized to most of Houston. This is the center I hate, loathe, and actively counsel patients against. So, dear lawyers for MD Anderson – I am not saying you do things illegally and immorally and disgustingly all the time. I am not saying you do it even some of the time. I am saying you did it at least once, which is enough for me to wish you ill for all eternity.
Fifteen-plus years ago there was a person I was well acquainted with although I was never her physician (so no HIPPA issues here.) Let’s call her Lisa. She had aggressive metastatic breast cancer and was being treated at MD Anderson in Galveston even though she lived in the metroplex area (a five plus hour drive.) She was aggressive in her efforts to treat this dreadful disease and wanted to go to the best place anywhere, so she did. This involved frequent trips, hotels and hospital stays and all the horrid complications of aggressive cancer treatment. She failed treatment despite everyone’s best efforts. Her cancer treatment team offered her an option of going on to a pharmaceutical company funded drug study for relapsed cancer. As always, she was aggressive in her efforts and signed right up. Over the months she got worse and worse and then clearly was well past the point of futility and she was dying. MD Anderson pushed and pushed for her to continue on the study and stay on the med. She did. It got even more obvious, well into hospice times. They urged, bullied, pushed, and she continued the treks, the meds, the dying – and she knew she was near death but decided to stay on the study to help future women faced with the same disease. She knew that her death would advance the science – if even just a little.
And then, a few days before her death, they came to her. I am sorry, but it seems a mistake was made, and your cell type was not appropriate for this study. We are sorry but we are removing you from the study and will not be able to count your data. Go home to die. So she did.
This is immoral and disgusting, and should be illegal. Skewing a drug study at the pain and eventual death of a lovely woman was and still is to me unthinkable. I grant that the cancer center did not kill her; cancer did. But they made that passage so much more miserable than it should have been. There is an old medical proverb – cure sometimes, relieve often, comfort always. MD Anderson Cancer Center, in this case, you did none of the three. Shame on you.
No Sir,it would not go before an ethics board today.The members of the ethics board are all investors in the pharma company and get funding for their pet projects. So approval all around.
The corruption is worse Now. Pray that people Change and make better decisions.
Anyone have VC firms buying local oncology practices? Look at how the same docs start pushing expensive therapies long past the threshold of futility.
My cousin’s husband, a gynecologist, had a uroepithelial malignancy and traveled back and forth to MD Anderson to try different protocols a few years ago…and still entered hospice care and died. I don’t know more details than that but I know I wouldn’t go there. I’m still angry at Duke for not being more aggressive with my uncle’s kidney cancer back in the 1970s, and of course he died at age 52. If the Taliban was playing Duke in basketball, I’d pull for the Taliban.
That’s a great “basketball” comeback Bill! I like it. My beautiful wife received palliative radiation for lung cancer locally and they did a good job.
Sad thing is she never smoked a cigarette in her life. Turned out our home was a Radon gas sink and she had to stay home and care for our mentally handicapped son. Hence the exposure. I had the house abated after her death and it’s essentially undetectable now on my meter. Now in Illinois a Radon gas report has to filled out before a home is sold. Back then it wasn’t required.
To the uninitiated, naturally occurring Radon gas rises up out of the ground and seeps into homes and is a major cause of lung cancer in those who never smoked. I had to find out the hard way. If we only knew when we moved to the area, we would have had the house abated before we moved in. I was 5 years older than my wife and expected to die first. I retired at 64 to take care of our son.
Same story, different place:
Columbia-Presbyterian, NYC, late 1980s, doc’s name was Dan Smith, if I’m not mistaken.
He had very nice cufflinks and perfect French cuffs, and a white coat with those little knots as buttons.
Stage IV Ovarian CA, discovered 3 years prior, beaten into submission with the nasties (cisplatin and doxorubicin), but recurred, with CNS mets.
Not a good prognosis.
She was in and out, but lucid when she was lucid. She was asked to participate in a trial of intrathecal chemo. She refused. She was done. She was also unable to fight, so they made a Burr hole and did it anyway.
I can tell you the result of the trial: It didn’t work.
Nowadays something like this would have gone before an ethics board or something, but not then.
That guy, and Columbia, are not my friends.