• Another lesson from cancer care 09 October 2017 | View comments

  • Following on from last week’s comparison of the care received by people receiving a diagnosis of cancer, with the perceptions of people receiving a diagnosis of dementia, I was drawn to Fay Schopen’s thought provoking commentary in the Guardian las Friday (6.10.17).

    ‘Cancer patients need more than survival. The hunger for ‘miracle cures’ has skewed medical research and made us forget that quality of life is key’.

    She has lived with a diagnosis of cancer for six years. Part of her commentary relates to this personal experience – the giving and receiving of the diagnosis – but mostly the life she has been leading since, most particularly the impact of medicines. The medicines have helped with some symptoms, but produced many others.

    Putting her personal experience into context, she refers to the papers in this week’s BMJ which are triggered by Davis et al’s retrospective analysis of cancer drugs introduced to practice 2009 – 2013. Davis et al. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by the European Medicines Agency 2009 – 2013. BMJ 2017; 359:j4530

    Of 68 new drugs approved, only 39 had good evidence of their effectiveness in moving survival or quality of life. After a median of 5.9 years of their use only six of those 39 had improved survival or quality of life. Amongst these six, improvements were mostly ‘marginal’ when compared with longer established treatments, but were much more costly.

    How can this be?

    People are so desperate for a cure, so keen to receive the latest ‘breakthrough’ therapy that moderate and sensible criteria are swept aside. Even Fay Schopen betrays a lingering hope/belief: ‘If you are surprised by what seems to be a devastating failure of medical research, so are scientists.’

    There have been advances in the understanding and treatment of many cancers. We surely cannot be surprised that gaining even more ground is difficult – and it may never happen.

    Living with that understanding makes for a manageable task. Fay Schopen concludes that quality of life within the available months or years is the most important consideration. This must be the case in all circumstances – of illness and of health. The impact of specific therapies may be significant, but it will always be but one component of the equation: inheritance, constitution, lifetime experiences, current social and psychological circumstances, spirituality and faith, not to mention other pathologies, will all have sway.

    Fay Schopen dismisses the metaphor of journey through illness: ‘something I have no truck with whatsoever.’ That puzzles me because I find the concept of life as a journey helpful and productive. I wonder what her alternative is.

    In this context it is important because the surest way to gain best quality from years with or without illness, has to be to travel with the benefit of a competent guide. For most of us, travelling in company with likeminded friends, in familiar places and with favourite music, pictures, foods, dance and such will make it good as can be.

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