Would your Oncologist undergo Chemotherapy?

In 1986, the British Journal of Cancer reported on a study from the McGill Cancer Center in Montreal, Quebec, one of the largest and most prestigious cancer treatment centers in the world, entitled “The use of expert surrogates to evaluate clinical trials in non-small cell lung cancer.” It was a study of oncologists done to determine how they would respond to a cancer diagnosis. They sent a questionnaire to 118 doctors who treated non-small-cell lung cancer. More than 75% of them recruited patients and carried out trials of toxic drugs for lung cancer. They were asked to imagine that they themselves had cancer, and were asked which of six current trials they themselves would choose. Of the 79 respondents, 64 (81%) said they would not consent to be in a trial containing cisplatin, a common chemotherapy drug. Fifty-eight or 74% of the oncologists found all the trials using any type of chemotherapy unacceptable. What reasons did they give? They said both the “toxicity of chemotherapy” as well as the“ineffectiveness of chemotherapy” were why they would not undergo those treatments.

The following year, the International Journal of Radiation Oncology, Biology, & Physics
ran the study, Non-small cell lung cancer: how oncologists want to be treated.
June 1987 Volume 13, Issue 6, Pages 929–934
William J. Mackillop, B.Sc. M.B. CH.B. F.R.C.P.
Brian O’Sullivan, M.B. B.C.H. M.R.C.P.(I) F.R.C.p.(C)
Glen K. Ward, B.Sc. M.D. C.M.
One hundred and eighteen Canadian doctors who treat lung cancer were asked how they would wish to be managed if they had non-small cell lung cancer. “Three per cent of doctors wanted adjuvant chemotherapy after surgery for early disease, 9% wanted chemotherapy for advanced disease confined to the chest and 15% wanted chemotherapy for symptomatic metastatic disease.”

British Medical Journal, 1990 Jun 2; 300(6737): 1458–1460
Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public, By: Slevin et al.
Cancer patients only needed only a 1% chance of cure to accept an intensive chemotherapy regimen described with many side effects. Cancer Nurses needed a 50% chance of cure, General Practitioners needed a 25% chance of cure, Cancer doctors needed a 10% chance of cure and the general public needed a 50% chance of cure.

British Journal of Cancer, Oncologists vary in their willingness to undertake anti-cancer therapies, August 1991, Volume 64, 391-395 By: Lind et al.
“The heterogeneity [differences] of the responses indicates that there is a substantial lack of agreement about the benefits of these ‘standard’ therapies, particularly in cases where palliation, rather than cure, is the goal. . .That oncologists were less willing to take an experimental therapy themselves than recommend it for a spouse is provocative…”
Oncologists vary in their willingness LINK

And yet this continues….

This PLOS ONE study published in May 2014 shows how litle has changed when it comes to financially motivated (Do as I say not as I do) treatments. Do Unto Others: Doctors’ Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance Directives, Published: May 28, 2014, By: Periyakoil et al
Stanford University School of Medicine, Palo Alto, California, U.S.A.
“Our data show that doctors they have a striking personal preference to forego high-intensity care for themselves at the end-of-life and prefer to die gently and naturally. This study raises questions about why doctors provide care, to their patients, which is very different from what they choose for themselves and also what seriously ill patients want.”

UK Daily Mail, “Most doctors who were terminally ill would AVOID aggressive treatments such as chemotherapy – despite recommending it to their patients.”

Oncology Times, Vol. XXVI, No. 15, Letters, PAGE 7 / AUGUST 10, 2004
Dr. George A. Omura, M.D., on Giving, and Not Giving, Chemotherapy
“The cancer chemotherapist gives chemotherapy; the medical oncologist should know when not to give it.”

Journal of the American Medical Association JAMA Oncology, Published online July 23, 2015
Chemotherapy Use, Performance Status, and Quality of Life at the End of Life By: Prigerson et al
“In 2012, an American Society of Clinical Oncology (ASCO) expert panel identified chemotherapy use among patients for whom there was no evidence of clinical value as the most widespread, wasteful, and unnecessary practice in oncology…Our findings did not demonstrate that patients who had received chemotherapy at baseline were statistically more likely to survive our study observation period…Unfortunately, and with rare exceptions, patients with metastatic cancer cannot conquer cancer (win the “war”) no matter how hard they fight. We have far too few effective curative treatments and interventions….are we honest with them [the patient] about the true potential benefit of the treatment? For many therapies, there is little evidence that life is substantially prolonged (for argument’s sake, let us define “substantial” as 2 months or longer).”

Journal of the American Medical Association JAMA Oncology, Published online July 23, 2015
Chemotherapy Near the End of Life: First—and Third and Fourth (Line)—Do No Harm
By: Charles D. Blanke, MD1; Erik K. Fromme, MD
“Why did patients with end-stage cancer who received chemotherapy have the same observed survival as those who did not?…Regardless, it is disturbing that this trial demonstrated no benefits of chemotherapy for patients with solid tumors or poor prognosis, and it is disconcerting that oncologists still recommend and use systemic therapy so close to patient death.”

The New York Times, July 23, 2015
Benefit of End-Stage Chemotherapy Is Questioned, By: Pam Belluck
“Chemotherapy is supposed to either help people live better or help them live longer, and this study showed that chemotherapy did neither.”

Journal of Clinical Oncology, 2012; 30(14):1715-1724.
American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. By: Schnipper, Smith, and Raghavan et al.
“The available guidelines established by expert panels have all concluded that if a patient’s cancer has grown during three different regimens, the likelihood of treatment success is so poor and toxicity so high that further anticancer treatment is not recommended.”

Oncologists vary in their willingness to undertake anti-cancer therapies

These are the same doctors who will tell you that their chemotherapy treatments will shrink your tumor and prolong your life.

oncologists-used-chemo-on-you-but-not-on-their-own-family-membersWould your oncologist take chemo?