Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds – from 5% to 15% – albeit with a poor quality of life.
Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
I am guessing that he had testing which determined it had spread and was terminal. It seems implausible that an otherwise healthy person would just pass up on a 15% chance of survival.
With a major bowel surgery? You’re looking colostomy bag combined with a tough recovery. That means pressure sores, painful chemo or radiation, substandard care in rehab, etc. Plus, pancreatic cancer usually comes back in force once you run that gauntlet.
My dad went through some of that post-stroke. No way.
15% for 5 years of unpleasant survival. Basically 0% chance for a “long” “normal” life after that.
My mother (who worked in medicine and was very healthy) was diagnosed with a GBM and had a brief course of radiation to try to shrink it without a ton of luck.
She stopped working and went home and had an OK year then an awful 4 months and then fell out of bed and broke her hip and never woke up.
She could’ve maybe had 2 or 3 pretty bad years if she’d “fought” and was “lucky.”
If it were 15% chance with a good quality of life, I'd take that treatment. But having seen several relatives live through a 'poor quality of life', I would not want that.
If I were given a 15% chance of survival (at best) where the most I could hope for was having a poor quality of life, I wouldn't be interested either. Even it at 2:1 it'd be a tough decision for me.
Given a long enough time horizon the chance of survival for anyone approaches 0%. At a certain point we got to come to terms with the inevitability of death. It really does not make sense to be performing elaborate, expensive proceedures on the elderly.
Thats the only way the patient discovers pancreatic cancer. It is only discovered earlier and treatably when a coincidental different test finds something. Sadly nobody even knows how fast pancreatic cancer grows so even increasing the frequency of tests doesn’t give you any recourse.
Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
I am guessing that he had testing which determined it had spread and was terminal. It seems implausible that an otherwise healthy person would just pass up on a 15% chance of survival.