Author: Wellness Club

The Mighty National Cancer Institute Is Looking To Make Some Changes…

By Nurse Mark

The medical news has been full of it recently:

• Mammography Screening Linked to Overdiagnosis of Cancer
• Prostate Cancer Overdiagnosis in the United States: The Dimensions Revealed
• Low-Risk Thyroid Cancer Overdiagnosed, Overtreated
• “Rethink” of Cancer Screening Triggers Comments and Controversy

Articles such as these cross our desk on a daily basis, making us wonder whether the conventional medical world has finally discovered that not every lump or bump has to be cancer and aggressively fought, or could it be that higher powers – the insurance industry, the government – have realized that they are in danger of foundering under the expense of all this diagnosis and treatment.

The Fear Factor

There’s no doubt that cancer is a terrifying word. It conjures up visions of debilitating illness, disfiguring surgery, toxic chemotherapy treatments, agonizing side effects from radiation therapy, and ultimately a painful and undignified death after which the grieving family will be left financially ruined.

So it’s good that the NCI has recognized that not every lump and bump, and not every “unusual” spot or shadow on a high-tech scan or mammography must be called “cancer.” Many of these things are just innocent lumps and bumps and spots. And many of them, if left alone (as they would be if we didn’t know they were there) would either quietly go away on their own, or remain unchanged for years, or maybe even grow and become annoying enough that we might then choose to do something about them.

With this in mind, the NCI has proposed that doctors be a little more cautious about how they describe these things to their patients.

The Evidence

From a paper titled “Overdiagnosis and Overtreatment in Cancer – An Opportunity for Improvement“

The practice of oncology in the United States is in need of a host of reforms and initiatives to mitigate the problem of overdiagnosis and overtreatment of cancer, according to a working group sanctioned by the National Cancer Institute.

Perhaps most dramatically, the group says that a number of premalignant conditions, including ductal carcinoma in situ and high-grade prostatic intraepithelial neoplasia, should no longer be called “cancer.”

Instead, the conditions should be labeled something more appropriate, such as indolent lesions of epithelial origin (IDLE), the working group suggests. The Viewpoint report was published online July 29 in JAMA.

“Use of the term ‘cancer’ should be reserved for describing lesions with a reasonable likelihood of lethal progression if left untreated,”

A Name Change

So, what were once give the frightening diagnosis of “cancer” are now to be called “indolent lesions.”

Indolent is from the Latin (a language your doctor might know a few words of…) In – meaning not, and Dolens – meaning pain. Indolent in this case means painless. Other definitions include “lazy,” and “slow-growing.” Lesion is defined as a localized change in a bodily organ or tissue from a wound or injury or other pathological process. A cut is a form of lesion, as is the scar that forms when it heals. A pimple is a lesion, as is a skin cancer. In other words, any lump or bump or sore can be described as a “lesion.”

Does this mean that we should now just ignore lumps and bumps and sore spots? Of course not!

What it does mean is that our doctors will hopefully now take a little more care with how they discuss these things with their patients.

Breast Cancer? Or Just a lump?

Instead of finding that little lump in a breast and striking terror into the heart of a woman with the diagnosis of “Ductal Carcinoma (cancer) In Situ” perhaps the more enlightened doctor will now say something like “Hmmm… a little lump there – perhaps an indolent lesion – let’s leave it alone and see how it is when you come back next year!”

Scandinavian countries have been taking this approach for years and have found that most of these lumps just go away on their own and never cause a problem. Those that don’t are then easily identified and treated, and thousands of women are spared unnecessary fear, diagnostic workups, and toxic treatment, disfiguring surgery and debilitating radiation therapies.

Men too…

Men can likewise be spared from the ravages of medical overtreatment that comes with a diagnosis of “prostatic intraepithelial neoplasia” (neoplasm is another word to describe “cancer”). It is well-known that most men, by the time they reach their seventies, could be found to have small cancers – if one looks hard enough. Autopsy after autopsy performed on men who have died from something else (including “old age”) reveal cancers that no-one – not the man nor his doctor – ever knew about or even suspected.

Sure, We’re Finding More…

The statistics make it very clear that over the past 3 decades or so with the explosion of scans, and diagnostics and our “war on cancer” the discovery rate for all these so-called “cancers” has increased greatly – but the death rate from them has remained fairly constant – despite all the treatments being inflicted upon those unfortunate enough to be so diagnosed.

Maybe finding and aggressively “treating” all those little lumps and bumps – now to be called “indolent lesions” – really hasn’t been doing much more than tormenting the poor, terrified patients and sucking the financial life out of the medical system.

Maybe the National Cancer Institute is right – maybe it’s time for a change.

Source article:

Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement
JAMA. 2013;310(8):797-798. http://jama.jamanetwork.com/article.aspx?articleid=1722196

“Stop” Says The American Society of Clinical Oncology – Stop the useless chemo, needless drugs, and unnecessary scans.

By Nurse Mark

The American Society of Clinical Oncology recently released new recommendations to it’s members, advising them to stop the unnecessary use of chemotherapy in patients with advanced cancers who are unlikely to benefit, to limit the use of granulocyte colony-stimulating factor drugs like Neupogen in patients undergoing chemotherapy, and to reduce the use of expensive scans and biomarker testing for the staging of early breast and prostate cancers and for detecting breast cancer recurrences.

While the actual ASCO report and recommendations are full of “weasel-words” and “yes-but’s” that allow doctors to find ways to continue to do all these things if they wish, this is an important step forward in the humane treatment of people with cancers.

In recommending that doctors stop chemotherapy in patients with advanced cancers the ASCO has recognized that, in many cases, when the disease is far advanced the treatment is worse than the disease and that for all the toxic side-effects of treatment, a patients life may only be extended by weeks or at most months – and that the “treatment” is likely to make that added time a miserable experience.

Instead, the ASCO recommends that patients be given “appropriate palliative and supportive care.” In other words, patients should be helped to enable them to enjoy whatever time they may have to live in comfort and dignity.

They also recommend limiting the use of hideously expensive and potentially dangerous drugs like Neupogen or Leukine (the two brand names available in the US) to those patients who are actually at high risk of developing a condition called febrile neutropenia from the use of toxic chemotherapy drugs – and the ASCO report acknowledges that there is a “clear overuse of these agents” and these drugs are often used inappropriately.

Finally, three of the ASCO’s “five recommendations” deal with the use (and over-use) of high-tech imaging, scanning, and diagnostic testing.

For example, they suggest that in patients with early-stage prostate cancer and early-stage breast cancer who have a low risk for metastasis, PET scans, CT scans, and radionuclide bones scans should not be used to determine whether the cancer has spread.

“These tests are often used in staging evaluation of low-risk cancers, despite a lack of evidence suggesting that they detect metastatic disease or survival,” the report says. “Unnecessary imaging can lead to harm through unnecessary invasive procedures, overtreatment, and misdiagnosis.”

Not to mention that they are obscenely expensive, often produce false results and cause unneeded anxiety for patients. Oh, and they expose people to huge doses of damaging ionizing radiation…

Speaking of obscenely expensive, a common theme throughout the ASCO report is an acknowledgement of the need to contain costs. The report goes on to conclude that the five things it discusses: “represents a series of practices in frequent use in common clinical scenarios that are not supported by strong evidence. Reconsidering their use, one patient at a time, is likely to improve the value of care that is provided, which in this case means the desired clinical outcome at the lowest cost to the patient and society.

So, in summary:

• No more “chemo ’til the last, dying breath.” Doctors are encouraged to know when to say “enough is enough” and to then concentrate their efforts toward helping their patients find and enjoy the very best possible quality of life – even though that life might be slightly shorter.
• No more “drug therapy because we can” just on the off-chance that it might prevent a problem. Doctors are being told to assess their patients, and commit drug therapy regimens on those patients actually at risk for the complications that the drugs are intended to treat.
• No more “willy-nilly” ordering of high-tech scans, imaging, tests, and other esoteric diagnostics. They most often don’t provide any significant information of value, the information that they do provide often does not affect the treatment choices anyway, and they frequently give false positives, resulting in patient anxiety and unnecessary treatment.

The ASCO “fact sheet” can be found here:

American Society of Clinical Oncology – Five Things Physicians and Patients Should Question

http://www.asco.org/sites/default/files/5things12factsheet.pdf

And the full report can be found here:

American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs: The Top Five List for Oncology

http://jco.ascopubs.org/cgi/doi/10.1200/JCO.2012.42.8375