1. I think a lot depends on the age factor. When you consider the treatments for the disease at an older age, the effects of aging on bodily functions and physiology cannot be ignored when making treatment decisions. Pharmacokinetic processes such as the absorption, metabolism, and excretion of drugs is different in older patients, and in general, a person's physiologic tolerance or reserve diminshes with increasing age.

You have less capacitance at 70 years of age than when you were 50. Older people are generally closer to some edge beyond which they would tip into a more clinically important organ dysfunction. If you are 82 and you have cancer, it is not likely to catch up with you. I think it is appropriate to make medical decisions in the face of competing risks and the expected course of the illness.

I had an Aunt, at age 81, that died from the treatment of her breast cancer, rather than dying with the cancer. The same could be said for someone being 70 years of age and having been diagnosed with prostate cancer. They would more likely die with the disease rather than from the disease.

Posted at 8:21PM on Jun 7th 2006 by Gregory D. Pawelski

2. early ID doesnt make sense if the chemo proves to be more harmful than the cancer. thye seem to have yet found a treatment regiment with chemo that really works - they nearly killed my mom with chemo and then said she would gain on average 1.5 months. they need a more targeted approach than chemo but the docs and pharmaceutical comp are geting rich off chemo even though the outcomes are often times not worth it at least with lung cancer)

Posted at 12:05AM on Aug 6th 2006 by Leslie H

3. Dalene said:

"Basically, they are warning us not to go looking for trouble. It seems high-tech imaging technology can detect very small lung abnormalities that might be clinically unimportant but lead to over diagnosis of lung cancer, and subsequent toxicity and premature death from treatments for lung cancer."

I did not see anything about premature death in the abstract you cite. If I may, what's the data on premature death in those who are treated who maybe should not have been treated? Toxins, of course, but premature death? Did the researchers say that? Just wondering?

Leslie H. says:

"they need a more targeted approach than chemo but the docs and pharmaceutical comp are geting rich off chemo even though the outcomes are often times not worth it at least with lung cancer)."

Your statement suggests that pharmas won't spend the R&D $$ on targeted approaches because they like the $$ from trad. chemotherapy approaches. Where's the proof these publicly owned companies are suppressing development?

Leslie states:

"they nearly killed my mom with chemo and then said she would gain on average 1.5 months."

If asked, the vast majority of oncologists will lay it on the line with the patient. They will tell them how much time they will get from chemo, BEFORE a decision is made, IF the patient really wants to know. Most don't. So the patient wants something. The doctor offers the patient THE something: traditional chemotherapy. He or she also gives out literature to read on the extensive side effects. After reading this, individuals can make up their minds. If I go to my doctor and I have an eye infection, I'll ask him what my prognosis is with or without the antibiotic drops. It's up to the patient to ask what the prognosis is with and without chemotherapy.

Also the statement, "he nearly killed my Mom" does not help others who are being treated. How did he almost kill your Mom? Did he not monitor her lab work? Did he overprescribe or make a medical error? Did he refuse to answer phone calls? Did he not administer anti-emetics or not offer her a transfusion? Answers to these questions would help others improve dialog with physicians.

The "he nearly killed" needs elaboration.

Most elderly patients do as well as younger patients with chemotherapy. Physicians run routine renal and liver function tests and prescribe based on these and other factors.

You may want to check this out:
http://www.australianprescriber.com/magazine/23/4/80/2/

Finally, in answer to the Mayo study, may I direct your readers to this article which should address this entire problem and which is being done at my hospital:

http://professional.cancerconsultants.com/oncology_lung_cancer_news.aspx?id=36889

Michelle

Posted at 8:44AM on Aug 6th 2006 by Michelle

4. After my mastectomy for breast cancer, I did further study into the odds I'd be facing with and without "traditional" chemotherapy. I had talked to several survivors who had different types of chemo and different reactions. What I did NOT like at all were some of the side effects and, in some cases, they were long lasting. Going through all of that for months on end seemed to me to be worse than the risk factor. So I did not undergo any chemo or radiation for my breast cancer. However, because my tumor was hormone receptor positive, I do take an aromatase inhibitor daily.

All of this is in the face of a pathology report that said: the tumor, although large, is well-defined, the margins are clear and there is no lymph node involvment.

Well, yeah...they got it all. What do I really need chemo for? This was MY decision and I don't regret it one minute. It is a decision any patient can make for any type of cancer.

Posted at 12:33PM on Aug 6th 2006 by MaryD