Treatment for cancer – who decides when enough is enough?

Treatment for cancer – who decides when enough is enough?

Cutting, burning, administering toxic chemicals… not an excerpt from a torturer’s handbook but the standard triumvirate of treatment for cancer. Surgery. Radiation. Chemotherapy.

Having experienced all three I’m all for the idea of skipping those that don’t make a difference to your prognosis, and I think this article makes interesting reading.

Obviously, it’s in everyone’s interest to limit treatment to what’s actually needed. As well as reducing trauma, pain and side-effects for patients it would save governments a huge amount of money. So good luck to the scientists dealing with the vexed question of when is enough enough? And to the doctors who must implement any new protocol.

Some people with cancer are very good at listening to the statistics, weighing up the odds and making a rational decision. Others are so frightened that they’re driven to everything in their power to get rid of it. Even if they’re told that a particular treatment might do little to improve their chances of survival, they’re likely to want it anyway.

There is also a huge variation in the attitudes of people whose cancer has spread and who know they can’t be cured. Some decide against treatment that will reduce the quality of the time they have left. Others are determined to squeeze every last second out of their life, whatever the physical or, for that matter, financial, cost. But should they be allowed to?

At a recent conference an oncologist said she dreads the increasingly-frequent situations where stopping treatment would clearly be the best course of action but patients and families are determined to continue. Another speaker, a neonatologist, pointed out that the money spent on extending someone’s life by a few weeks might buy decades of life for a premature baby.

At the moment, who gets what can be determined by the beliefs of an individual doctor, the policy of a particular hospital or even the strength of the associated lobby group. As pressure on the health budget continues to mount, someone, somewhere is going to have to take responsibility for creating a more equitable and consistent approach.

Cutting out unnecessary treatment is a good place to start. But, then, who should we appoint to weigh the value of one life against another?