Oncology care and end of life choices

Since I first started working in the pharmaceutical industry, a year ago, I have been conflicted about the cost and limited increase in lifespan that oncology drugs offer to metastatic patients. This statement risks putting a value on people's lives and makes judgments about what is meaningful to any one individual, but the high cost of oncology treatments and the often short increase in survival rates perturb me.

Last year, Atul Gawande wrote in the New Yorker about the value of hospice for dying patients, both for the patient and for the family who has to watch a loved one die. The article suggested that in lieu of the very expensive and highly toxic treatments, choosing palliative care might be a more graceful way to confront the end of life. I reference this article a lot in various conversations because it affected me deeply. It made me cry.

Now, in the context of debates about Medicare cuts, there is a post in The New York Times about the high cost of oncology treatments at the end of life and their often limited ability to significantly extend life. As the columnist, Mahar, notes at the very end of her opinion piece, research suggests that people who die in hospice care often live longer than those who remain in the hospital. While shorter survival for those in hospitals could very well be due to the higher rate of secondary (or tertiary) infections, there could also be a real benefit to dying in a less sterile environment, surrounded by people who are important to you, rather than a roster of medical professionals.

This is not a simple anti-pharma screed, but rather an attempt to think more seriously about what it means to die, what it means to be caught in the pharmaceutical complex, when under duress and facing limited options, and a challenge to where our priorities really lie when we talk about improving cancer treatment options.

In other news, I just stumbled across the fascinating and seemingly awesome Breast Cancer Action group. They have a campaign, Think Before You Pink, that criticizes the pinkification of breast cancer, turning "support" into a questionable consumerist practice often supporting companies who use chemicals known to be carcinogenic. This merits its own post, but I recommend learning more about them and supporting their work.