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Posted 4/13/2015 5:29 PM (GMT 0)
Why Survival rate is not the best way to judge cancer spending
http://www.nytimes.com/2015/04/14/upshot/why-survival-rate-is-not-the-best-way-to-judge-cancer-spending.html?&hp&action=click&pgtype=homepage&module=mini-moth®ion=top-stories-below&wt.nav=top-stories-below&_r=0
Posted 4/13/2015 6:17 PM (GMT 0)
Hmm, not sure reading that made me feel "good"....
Posted 4/13/2015 9:56 PM (GMT 0)
Me neither Thurman...
Posted 4/13/2015 9:59 PM (GMT 0)
OMG, I am going to die!!!
Posted 4/13/2015 10:28 PM (GMT 0)
I'd be questioning what this author's spin is. What's he trying to argue? That the cost of treatment is too high compared to the outcomes? Or that overtreatment is happening? No argument to either of those points. Does everything have to have a dollar value, including life? I'll need to read it again, a bit more carefully.
Posted 4/14/2015 12:46 AM (GMT 0)
Trudging toward what my cynical thoughts have long expected.

Eventually, we'll be judged on how much money we can generate with our remaining years with vs. without treatment. If treatment cost exceeds potential revenue (to whatever entity provides the treatment), then no treatment. Not "cost effective". Like a damaged car, if it costs more to repair than it's worth you scrap it.

Things like pancreatic cancer, or perhaps lung cancer, with very ominous prognosis and usually relatively short survival, no treatment would be worthwhile. Not generally curable, not a long life extension, but high cost for treatment (like 12 chemo sessions, for example, ranging from $25,000 to $50,000).

My diagnosis, scans, radiation and HT for prostate cancer has run probably upwards of $150,000. I'm in a decent income bracket with a few years left, but even so will my premiums ever compensate for that cost? How long would I have survived without any of that expense? How long with it? No one can tell me. Some bureaucrat could look up some kind of bogus data to come up with a number though, I'd bet.

That whole line of reasoning could lead to some pretty unpleasant futures.
Posted 4/14/2015 12:56 AM (GMT 0)
Redwing, thanks for putting into words what I, also, was thinking.
Posted 4/14/2015 1:45 AM (GMT 0)

Somebody said...
We averted almost 60,000 deaths from prostate cancer..........For prostate cancer, we spent almost $2 million per QALY gained.

I am confused as usual. I have not spent- nor has my insurance paid- anywhere near 2 million. So how does that work?
Posted 4/14/2015 1:50 AM (GMT 0)
start of rant/
Research is expensive and every patient treated is a data point in that research. I'm not referring to trials but actual practice. While the "thumb scanner" moved up the diagnosis 5 years only to find not all lumps become fatal, that is a data point that will inform other research. It's true, some drugs are $50k for an additional month of life but the pay back is a bit of knowledge. Some of the treatments in the 1970s were a kings ransom and $10 today. Dr. R. Ablin invented the PSA test in 1972 and spent years claiming it did not detect cancer. A PSA test in 1973 $5k and not covered by insurance. We would still be letting blood if early high cost procedures were not applied due to cost.
/end of rant
Posted 4/14/2015 1:54 AM (GMT 0)
What, exactly, is a "Quality of life year (QOLY)"?
Posted 4/14/2015 4:01 PM (GMT 0)

Halbert, this term has been defined several times over decades by several different medical statisticians, and used basis by many types of doctors either openly & explicitly, or sub-consciously as they make recommendations to patients on a daily basis.

One of the very well known statisticians, Edward Kaplan described it this way (Kaplan is best known for the “Kaplan-Meier estimator” used ubiquitously in medical studies to estimate patient survival rates, taking into account the fact that some patients may have died during a research trial while others survive beyond the end of the trial—if you’ve ever read a cancer study, you have undoubtedly seen the KM curve):

“The quality of life component of the model considers behavioral scales of mobility, physical activity, social activity and symptoms. The model also allows for the aggregation of profiles onto a single utility scale that ranges from 0 (for death) to 1.0 (optimum health), and this is a very important component of the model. These weights are derived from community surveys that assess the social preference or utility for observable states of function. A score of 0.60, for example, suggests that an individual is in observed state of functioning for which utility is about 60% of the distance between optimum functioning and death. The person remaining in thei state for one year would have lost 0.40 well-years of life.”

On the other hand, anyone who has ever experienced a close loved-one suffer through a fatal cancer experience knows intuitively exactly what this means…

Posted 4/14/2015 5:36 PM (GMT 0)
This article never mentioned death by other causes. How many of the mortality cases could be chalked up to the proverbial hit by a bus? Furthermore, this article never mentioned extended life due to a healthy diet and exercise. Maybe I'm missing something but it reads like an exercise in how to screw with statistics . . . Q
Posted 4/14/2015 6:26 PM (GMT 0)

BillyBob@388 said...

Somebody said...
We averted almost 60,000 deaths from prostate cancer..........For prostate cancer, we spent almost $2 million per QALY gained.

I am confused as usual. I have not spent- nor has my insurance paid- anywhere near 2 million. So how does that work?

It works like this:

It has nothing to do with what you and your individual unique case spent, or my individual case.  Those would be what we call "anecdotes" or "anecdotal evidence," and sometimes refered to as "one-off's."  Anecdotal evidence is often indicated by opening sentences like, "I know a person who...," or "In my case..."

The understanding of this starts with the recognition that over 90% of men diagnosed with prostate cancer live normal, full life expectancies.  If you read the article and understood the premise of how the survival rate for PC has changed dramatically but the mortality has changed little, then you understand the extent of overtreatment, and the big $$$ spent on overtreatment...for little or no impact on added years of life.  So the total $ spent on all PC is having a relatively small (not none) affect on adding years...or stated in the inverse, a large $$$ is spent for just one year, or a QYOL.  $2 million, apparently, for one PC QYOL.

In another posting, halbert asked:  "I'd be questioning what this author's spin is. What's he trying to argue?"

I thought the author's point was quite clear, and I think he said this.  The money spent on overtreatment would be better spent on other medical needs.  We all seem to "know" this, but "we" collectively don't seem to be acting upon this they way that rational thought would dictate...

Post Edited (JackH) : 4/14/2015 12:29:56 PM (GMT-6)

Posted 4/14/2015 10:21 PM (GMT 0)
I read an article like this....and it comes close to saying that cancer treatment in general doesn't pay off. We spend all this money for what? And then I note that the doctor writing the article is an obstetrician. Sure, he sees some cancer patients....but mostly he's likely more involved in other medical activities.

We all have anecdotes on this subject. My favorite was a contrasting situation I observed a few years ago: I knew two families with cancer patients. Family #1 had a 9 year old with non-hodgkins lymphoma...a completely treatable childhood cancer. She went through a year of chemo and has had a full recovery. Family #2 had a 90 year old who developed colon cancer. The decision was made to treat full on. Surgery, chemo. Then she fell and broke a hip. They installed a prosthesis. She died at 92 of fundamentally old age. I've considered the contrast. The dollars spent on both patients were probably equivalent. Who got the most benefit?

This whole discussion (and the recent one from S. Korea on Thyroid cancer screening that some of you may have seen) cries out to me for better screening and better diagnostics. Maybe someday we'll have the tools in the PCa world to unequivocally state to a particular patient: You're a true G6, and no matter how long you wait, you'll never die of PC. We're not there yet.
Posted 4/15/2015 4:43 AM (GMT 0)
It will get better at some point,... but not soon{operative word}… Ya know what I mean ... the underlying thread of this thread, is endemic to the times. And As Jack H says to another point " We all seem to know this"
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