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Aggressive Care for Dying Cancer Patients Futile, Study Finds

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Aggressive Care for Dying Cancer Patients Futile, Study Finds

"Many Medicare cancer patients with poor prognoses are receiving
overly aggressive and expensive inpatient procedures in the last
month of life, including chemotherapy, intensive care,
intubation, and feeding tubes, despite not much evidence that at
that point, it will do any good.

That's the conclusion in the latest report from the Dartmouth
Atlas Project, which says that quality of end-of-life cancer care
and use of hospice and palliative care services in a cancer
patient's last month of life are enormously variable, depending
on the hospital referral region and the specific hospital or
health system where the patient sought care."

Read the rest here: HealthLeaders Media, November 17, 2010

Oh well..... Money makes the world go 'round....

Best wishes,

John

tootsie1's picture
tootsie1
Posts: 5065
Joined: Feb 2008

It's just always hard for patients, and especially their families, to face that goodbye. I can understand that.

*hugs*
Gail

PhillieG's picture
PhillieG
Posts: 4912
Joined: May 2005

I think it's tougher on families to say goodbye.

PhillieG's picture
PhillieG
Posts: 4912
Joined: May 2005

I know people have a hard time "letting go" but death is a fact of life. This is not only true for those with cancer but for many people who are just really ready to die because their bodies are failing. Right now my family is faced with our Mom's declining health. She is 91 and lived a good life with very few health issues until recently. Now, her kidneys are failing. She could go on dialysis but at 91 and the shape her body is in she does not want to put herself though that. For the past few months she has been in a hospital, then in a rehab facility to help her regain strength to walk (with the aide of a walker), then back to hospital, then rehab...etc. The decision, which she alone made, is that she has had a enough and is ready to let things play out as they will. We have had to make sure that copies of her DNR (do not resuscitate) and other papers to insure that doctors will not keep her body functioning while she is basically not living just because they have the ability to have machines do everything for us so we are not totally dead. IF any of those papers, which had to be re-written each time she transferred to another facility, were not up to date they would not let her go in peace. While none of us are looking forward to the day she passes away, we respect and understand her decision.

Not to sound cruel but part of why the cost of health care (a funny term in this context) is so out of control is that very often people will do whatever the doctors say they can do to keep GrandPa "alive" (or not dead is more like it) and not realize that 91, or 95, or 82, is as long as some people live. I know that I would not want to be kept from dying and put on machines for x number of years just because they have the technology to do that. So then, hundreds of thousands of dollars are spent to keep someone from dying a natural death and possibly extending their life for 2 weeks. I'm sorry but I don't understand how that helps anyone, especially the poor person who's body is done.

Of course I am not talking about someone whose body is in good health and are in a situation where there is a temporary setback that causes the use of heroic measures. I just think that there are few things as horrible as not being allowed to die in peace.

Many people are just afraid to let go or their families are afraid to lose them. I don't think they always take into consideration the person's wants and wishes. I don't expect many people to agree with me.
Thanks for posting this John.
-phil

Lovekitties's picture
Lovekitties
Posts: 3372
Joined: Jan 2010

I, like you, feel that there comes a time when it is better to let there be a peaceful passing.

I think that doctors and relatives are afraid of being seen as 'not doing everything possible' for the patient.

I for one have made sure my family understands, and the paper work is in place, that I don't want to be kept 'mechanically' alive. I fully believe that the patient has the right to determine when enough is enough.

Marie

Jaylo969
Posts: 827
Joined: Jan 2010

I agree with you Phil.

One thing that helps is if the loved one has legally selected one person who knows and agrees with them on their philosophy of living and dying. Make them their personal representative/power of attorney.This especially helps in large families where everyone is on a different page when it comes to allowing their loved one to die with dignity vs. doing absolutely everything to keep their loved one around another couple of weeks.

This subject can get very 'touchy' as I'm sure you realize since you don't expect many people to agree with you.

-Pat

Kerry S's picture
Kerry S
Posts: 607
Joined: Dec 2009

I could not agree with you more Phil

Prolonging life is just cruel to both those left behind and the one going. I read a few months back about some life prolonging drugs that cost 10K and extended life an average of 2 months. That is not a good ROI.

As a society, I think we must look at the fact that there is just so much in the health money bucket to spend. Why blow it on what is going to happen anyway.

Being a hard line conservative, I don’t want to end up just a body that happens to have a heart beat. I keep what I call my “check out pills” in the house. I have enough to put a damn horse down with a smile on his face.

I told the brain surgeon that if he screws up a little getting that damn thing out, to just screw up and slip a little more. From the look on his face, he understood me.

Kerry

KathiM's picture
KathiM
Posts: 8077
Joined: Aug 2005

I have a DNR. And specific instructions...

The Netherlands has a way to support graceful death...maybe I should go there when I'm sure I'm done...

After seeing my 87-year-old mother dwindle away, and her loss of cognitive abilities along with it, I REALLY DON'T want to live like that...sigh...I told my daughter that when that time comes for me, please, take me out in a field and shoot me (joking, guys...she would be in jail...lol!).

Hugs, Kathi

tanker sgv's picture
tanker sgv
Posts: 125
Joined: Nov 2010

Your story hits home with me. My mom was 47 and passed away last night. Three weeks ago she was in the hospital and she told me she was done with doctors and wanted to die in the comfort of her own home. 2 hours later i was driving her home and promised her i would never let her be in a hospital again. She died a painful death but her last day she had peace. Families need to let the patient decide. Its there mortality

Kathryn_in_MN's picture
Kathryn_in_MN
Posts: 1258
Joined: Sep 2009

I am so sorry to hear about your mother. It is wonderful you respected her wishes, and her final weeks were spent at home with you.

I'm your mother's age and worry about my 4 children should the day come soon for me. I hope you have a good support system of other family and/or friends to help you through this difficult time.

herdizziness's picture
herdizziness
Posts: 3642
Joined: Apr 2010

Dear Phil,
My father-in-law of a husband years past, had kidney failure after his heart surgery.
He decided dialysis also was not for him. We accepted that, it was his choice, his life, he was 78, he tried dialysis, he did NOT like it, wasn't worth the exhaustion after and then just as he'd barely start to recover, back to dialysis.
I loved this man dearly, but understood his decision.
I just want to let you know, that after her kidneys go into full failure, she will have about a week left. They told us it was a painless death, if they tell you this, don't believe them. After two days, he would beg us to get off of his legs, he couldn't stand the pain. No one was touching his legs. He asked for steak for his dinner and the nurse informed him he was on a diet. The man was dying and they tried to keep him on their diet. Needless to say, but I will anyway, he got his steak.
We let him go, although back then, the nurses treated us like **** for not agreeing to keep him alive, not to go against his wishes, not to plead for him to live and endure the dialysis.
We let him go with love in our hearts, with understanding of his wishes, with deep sorrow at saying goodbye.

Jaylo969
Posts: 827
Joined: Jan 2010

My Mom was dx'd early June w/advanced, aggressive cancer spread throughout her body. It took many appointments with various specialists, many painful procedures to finally get her an appointment with an oncologist at the end of July.Medicare took a huge licking paying for all these doctors and procedures. When we get to the oncologist he looks at her and states he can't do anything for her and offers Hospice.

I believe the first doctor could have safely done that for her and eliminated all of the middle men and students.Just my thoughts on the matter.Every case is different, I'm sure.

-Pat

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Re:
"When we get to the oncologist he looks at her and states
he can't do anything for her and offers Hospice."

You can read my "profile" page to get a better understanding
of where I am in life regarding these matters.

There are other things besides "oncology" to use to fight cancer,
and sending a living being to "hospice" without having offered or
suggested those "other methods", does not fit into my idea of what
survival is all about.

The problem with present mainstream medicine, is that can take
such a horrible toll on those that are fighting for their life, that
death can appear to be a better choice.

It ain't over, 'till it's over.

There -are- other ways.

Best thoughts and wishes to you.

John

Jaylo969
Posts: 827
Joined: Jan 2010

How's it going John? You know, I have read your profile many times ( just read it again!) and I tend to read every post you make, trying to understand what you are REALLY saying.

All I was trying to say is that my 81 yrs old, 100 lb. Mother went thru' 5 painful and dangerous procedures in a teaching hospital BEFORE they would refer her to an oncologist. The procedures DID unfortunately hasten her will to die.I feel like it is a waste of Medicare/insurance money to do most of those procedures seeing as how she had mets to both lungs, shoulders, upper legs, throat and very possibly brain.The tumors were huge.And I did not send her out....I brought her home and Hospice came to her home.

I probably didn't even understand either of your statements but if we are speaking of TCM she could not even swallow jello.And, in that huge teaching hospital...not one doctor offered ANY way...traditional or otherwise.

I really respect the points you make about doctors, western medicine, money grubbers, etc.
I know you are sincere and I wish that I had met you and gained some knowledge about those 'other ways' before I submitted to some of the things that I did.

-Pat

John23's picture
John23
Posts: 2140
Joined: Jan 2007

Re:
"I tend to read every post you make, trying to understand what you are REALLY saying."

Try not to read anything "into" my comments; just take them as
literally as they were intended. And thanks for the compliments!

We -all- (me included) are very sensitive to other's comments,
always wondering if the comments are directed at us, rather than
someone else. It's just an inherent problem of forum life.... there's
just isn't enough we can do with text to get a point across when
the other party can't see our facial expressions, or other physical
nuances that allow for a better understanding of the context of
a comment. I try my best to -not- attempt to "read into" any comments,
and just take the comment as it is in the context of the general theme.

My gripe is just as I stated... instead of informing a patient of
other possible options to fight cancer when all the conventional
procedures fail..... the practitioners provide information about
"end of life" care.

What they're saying is:
"If what I have doesn't work, accept death as the remedy".

How many do we see here, that have been told that there is
no medical hope for them, and yet years later they are still here?

I was handed forms for hospice while I laid in recovery, unable to
sit up from my extreme dehydration that went mis-diagnosed
until it was nearly too late....

Had I signed the forms, would I be here now?

I was told I would have a 50/50 chance to survive with chemo,
and -no- chance without. I'm still here 4 years later, never having
touched chemo. Is it just luck? Was hospice my only other option, as
they informed me? Was it just a scare tactic; part of business as usual?

We all deserve the best shot at living, yet we are denied -all-
the possible paths due to an industry that wants to get every
last dollar out of every last patient.

I posted this thread to help others understand that the industry
is more geared to help their industry survive, than the very patients
they should be helping.

They are willing to pump toxins into weakened bodies, knowing
it will do no good, rather than suggest other possible options
for health care that might even save a life or two.

You did what you could for your mom. It's sad that it couldn't have
worked out better, but we can't live without eventually dying;
every life only lasts just so long, and we can't predict how long
that might be.

Not one of us can tell -if- she got different medical treatment,
that she might have lived... There is no way to know that.

But we should learn from history, and attempt to correct what's
wrong, otherwise those that did die due to a greed-filled industry,
will have died in vain.

Sorry about your mom.

Best wishes to you!

John

Kerry S's picture
Kerry S
Posts: 607
Joined: Dec 2009

I just had a blast out splitting wood and putting the snow blade on the tractor. While doing it, I was deep in thought about this subject.

The one thing I do think should be done by us old guys and gals is let them test drugs and technology on us if we get down to the final part. Don’t take this wrong as I still very much intend to beat this crap, but think of the knowledge we could leave behind us.

Then the younger folks with young families on this board could maybe get value from our passing.

I intend to talk about this with all my docs. Yes, I know “you can tell the pioneers by the number of arrows in their backs.”

Kerry

AnneCan
Posts: 3692
Joined: Oct 2009

What kind thoughts! And I am amazed with all you are physically doing after the cr$% you have been through. Is that the new log splitter in the photo?

Kerry S's picture
Kerry S
Posts: 607
Joined: Dec 2009

Ann darlin,
My body needs that work to get in shape to do this reversal. With us old guys its called use it or lose it. Its just my way to beat this crap.

I just came in from missing a 50 yard shot at a nice doe. I missed. Scary old woman said not to go again. God does not want me to shoot one this year.

Kerry

AnneCan
Posts: 3692
Joined: Oct 2009

but that looks like an impressive rig. I guess the doe is lucky; she dodged the bullet.

KathiM's picture
KathiM
Posts: 8077
Joined: Aug 2005

(note the spelling!).

It's food for thought, I MUST say. Along those lines, I was refused every clinical trial I tried for...guess why....

I was a warrior of 2 cancers...would screw up their stats...BUT, how many of we '2-fer's do you know? I know many!!!

Hugs, Kathi

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