If you are a scientist, and if you have done many scientific experiments / research in your life, and if you have a bit of common sense (never mind about having a Ph.D. — these days you can buy one easily), you will know that something is not right with the current medical way of treating cancer using poisonous drugs.

Well, I am not a medical doctor – in a way, that is a blessing because I can critically “see” that something does not add up.  Why?

But, let me also say this. You don’t need to be a scientist to “see” what I see and to know what I know.  Hear what a broadway playwright and a movie star has got to say:

In this article, I am not trying to tell you how bad or how good chemo is.  I think you have had enough of that. I am going to bring you yet another different but related message.  I hope you can learn many things from what is written below.

The recent website of the Dana-Faber Cancer Institute, Boston, USA, had this headline: Advanced cancer patients overoptimistic about chemotherapy’s ability to cure, study finds

http://www.dana-farber.org/Newsroom/News-Releases/Advanced-cancer-patients-overoptimistic-about-chemotherapys-ability-to-cure-study-finds.aspx

A study was conducted and led by medical researcher, Jane Weeks, who is also a professor of medicine at Harvard Medical School and Professor of Health Policy and Management at Harvard School of Public Health.

Others in the research team are Deborah Schrag, MD, MPH and Paul Catalano, ScD, Angel Cronin, and Jennifer Mack, MD, MPH, of Dana-Farber; Matthew Finkelman, PhD, of Tufts University; and Nancy Keating, MD, MPH, of Brigham and Women’s Hospital.

What Did They Study?

• The study was conducted by surveying 1,274 patients at hospitals, clinics and treatment centers across the USA. Participants were recruited from geographically diverse populations and health care systems in order to systematically evaluate cancer care delivery in the U.S.
• Study participants had been diagnosed with metastatic lung or colorectal cancer at least four months earlier and had received chemotherapy for their disease.
• They studied their records in great detail.

The Results of the Study 

They found that 69 percent of patients with advanced lung cancer and 81 percent of patients with advanced colorectal cancer did not understand that the chemotherapy they were receiving was not at all likely to cure their disease. Their expectations run counter to the fact that although chemotherapy can alleviate pain and extend life in such patients by weeks or months, it is not a cure for these types of advanced cancer except in the rarest of circumstances.

• Patients with advanced lung or colorectal cancer are frequently mistaken in their beliefs that chemotherapy can cure their disease.
• Inaccurate expectations about the role of chemotherapy were found among patients from varied backgrounds treated in many different health care settings across the U.S.
• Surprisingly, patients who rated their communication with their physician highly were the most likely to hold overoptimistic views about chemotherapy’s curative potential.

• Strikingly, those patients who rated their physicians as worse communicators were more likely to have a realistic view of the potential benefit of their chemotherapy.

• While there is no doubt that communication about prognosis in advanced cancer is challenging, a sizeable minority of study participants did grasp the incurable nature of their cancers.

• Dr. Weeks noted: “If patients do not know whether a treatment offers a realistic possibility of cure, their ability to make informed treatment decisions that are consistent with their preferences may be compromised. This misunderstanding may pose obstacles to optimal end-of-life planning.”

• Dr. Deborah Schrag said: “skilled clinicians can set realistic expectations without their patients’ losing either hope or trust.”

This study was published in the Oct. 25, 2012 issue of the New England Journal of Medicine. The study was funded by grants from the National Cancer Institute and by a grant from the Department of Veterans Affairs

Mass Media Response To The Results Of This Study

1. Are cancer patients’ hopes for chemo too high? http://www.reuters.com/article/2012/10/24/us-cancer-patients-idUSBRE89N1M220121024 

• At least two thirds of people with advanced cancer believed the chemotherapy they were receiving might cure them, even though the treatment was only being given to buy some time or make them comfortable.
• Their expectations are way out of line with reality,
• Perhaps ironically, the patients who had the nicest things to say about their doctors’ ability to communicate with them were less likely to understand the purpose of their chemotherapy than patients who had a less-favourable opinion of their communication with their physicians.
• This is not about bad doctors and it’s not about unintelligent patients.This is a complex communication dynamic. It’s hard to talk to people and tell them “we can’t cure your cancer.”
• Doctors find it uncomfortable to hammer home grim news and patients don’t want to believe it.
• It was a reminder to doctors to slow down and take some time to realize how hard the issue is.
• If patients actually have unrealistic expectations of a cure from a therapy that is administered with palliative intent, we have a serious problem of miscommunication we need to address.

Hossein Borghaei, an oncologist at the Fox Chase Cancer Center in Philadelphia said:

• What are you supposed to do, stand in front of someone with advance disease and argue with them? It’s not productive.

Thomas Smith and Dan Longo of Johns Hopkins University School of Medicine wrote:

• The results are probably due, in varying degrees, to patients not being told their disease is incurable.
• Patients not being told in a way that lets them understand.
• Patients choosing not to believe the message, or patients being too optimistic.
• Many patients think they are going to beat the odds.

2.      Many cancer patients mistakenly believe chemotherapies will cure them, new study says

http://www.boston.com/dailydose/2012/10/24/many-cancer-patients-mistakenly-believe-chemotherapies-will-cure-them-new-study-says/P4Sv84A5u4syPuWeD9ANUI/story.html

• A majority of patients with advanced lung and colorectal cancer harbor the fundamental misperception that treatments that can extend life and alleviate pain might also cure them.
• But the study couldn’t pinpoint where it occurs: whether patients receive unclear information from a physician or fail to fully comprehend what they are told, or whether there is a kind of clinical “collusion” in which the discussion moves rapidly from a dire prognosis to a focus on what can be tried, leaving patients with an inflated sense of hope.
• The issue here … thinking that a treatment offers a chance of cure when in fact it doesn’t. This deprives these patients of the opportunity to weigh the risks of chemotherapy, including the chance of some rough side effects, against the true benefits, perhaps some symptom relief and a few months longer life but no chance of cure.

Dr. Eduardo Bruera, chair of the Department of Palliative Care and Rehabilitation Medicine at the University of Texas MD Anderson Cancer Center, said:

• A bearer of good news might be seen in a more welcoming way; that might explain why sugar-coating might make people more liked by their patients.

Dr. Deborah Schrag, a colorectal cancer specialist at Dana-Farber and co-author of the study, said:

• We had this hypothesis when it comes to giving bad news: Doctors who work at an integrated health care network, they’re not an independent practice, they’re more free to disclose the unvarnished truth, without worrying about the ramifications of, ‘If I’m not super cheerful and positive and optimistic, my patients would not like me.

Dr. David Ryan, chief of hematology/oncology at Massachusetts General Hospital said:

• You have to provide the information about whether a situation is curable or not curable, and what the odds of doing well are for a long period of time.
• But you also have to provide hope, and it can be difficult sometimes to convey that difficult information and also provide hope.

Oncologists said it was crucial to find where and why the misunderstanding takes root so that doctors can be sure their patients are making informed decisions.

3. Many Terminal Cancer Patients Mistakenly Believe A Cure Is Possible http://www.capradio.org/news/npr/story?storyid=163572138 

• A survey finds that the majority of advanced stage lung and colon cancer patients believe chemotherapy might cure them, when it can actually only buy them a few months. Oncologists are worried about how this impacts end-of-life decision making.
• Doctors are often called upon to deliver bad news to patients, and there isn’t much that’s worse than a diagnosis of an advanced-stage cancer for which there is no cure.
• A large majority of patients who receive this news don’t fully comprehend it, or perhaps willfully choose to ignore it.
• When people have unrealistic expectations they’re much less open to discussing end-of-life planning.
• But patients always want positive news. In the short term, people will be happier if you give them happier news.”

Sandra Swan an oncologist at the Washington Hospital Center said:

• Ultimately the doctor’s responsibility is to ensure that their patients fully understands what’s happening to them.
• There needs to be continued communication about the prognosis and it needs to be done early on. I don’t think physicians do it particularly well. … Many physicians just have a very hard time communicating that they’re not going to be able to cure the patient.
• Doctors need do a better job of helping terminally ill cancer patients let go of false hopes without squashing all hope.
• You don’t want to take away hope from patients. They’re not going to be cured but it’s not like they’re going to die instantly. So it is a really hard balance to achieve.

4.   Most patients with incurable cancer still think they’ll survive, study finds

http://www.cbsnews.com/8301-204_162-57540242/most-patients-with-incurable-cancer-still-think-theyll-survive-study-finds/

• Many patients who receive chemotherapy for incurable cancers still believe they can beat the disease, a new study suggests. The researchers behind the study question if patients are simply in denial or doctors are skirting the truth with their patients’ prognoses.

• The research also highlights the problem of overtreatment at the end of life — futile care that simply prolongs dying.

• For cancers that have spread beyond the lung or colon, chemo can add weeks or months and may ease a patient’s symptoms, but usually is not a cure. This doesn’t mean that patients shouldn’t have it, only that they should understand what it can and cannot do, cancer experts say. But often, they do not.

Dr. Thomas J. Smith of Johns Hopkins University School of Medicine and Dr. Dan L. Longo, question:

• Whether patients are being told clearly when their disease is incurable. Patients also may have a different understanding of “cure” than completely ridding them of a disease – they may think it’s an end to pain or less disability.

• If patients actually have unrealistic expectations of a cure from a therapy that is administered with palliative intent, we have a serious problem of miscommunication.

How should doctors have this difficult conversation with patients?

Smith told CBS This Morning that doctors should operate on an “ask, tell, ask” basis when patients are faced with a life-threatening illness. That means doctors should ask patients up front how many details they want to know about their illness. Then, they should tell patients in understandable terms their prognosis, such as by saying “based on people like you, you may have weeks or months.”

While some patients may have positive attitudes and think they’ll still beat the disease, Smith says he’ll tell patients that doctors won’t stand in the way of miracles, “but we can hope for the best but still need to plan for the worst.”

The study raises concerns about unnecessary but costly medical treatments for dying patients.  Smith said having the difficult conversation with a patient about their end-of-life care may lower these costs because many patients may want to be comfortable at home, and not in a hospital. This really isn’t about saving money, so much as honoring people’s choices.”

Read more on CBS: Doctors unveil “Choosing Wisely” campaign to cut unnecessary medical tests  http://www.cbsnews.com/8301-504763_162-57409204-10391704/doctors-unveil-choosing-wisely-campaign-to-cut-unnecessary-medical-tests/?tag=contentMain;contentBody

Should parents’ belief in miracles trump medical expertise in end-of-life decisions? http://www.cbsnews.com/8301-504763_162-57493154-10391704/should-parents-belief-in-miracles-trump-medical-expertise-in-end-of-life-decisions/?tag=contentMain;contentBody

Truth Is a Bitter Pill – Hard For You to Accept Reality

Chemotherapy Game Changer for Stage 4 Cancer http://www.envita.com/cancer/finally-chemotherapy-game-changer-for-stage-cancer/?UA-29060687-1

• The current model and approach being used by numerous cancer centers and hospitals is the “germ theory.” This model aims to focus on destroying cancer cells using a “one size fits all” protocol.
• The doctors at Envita explain that each person’s cancer is unique and cannot be put into one category or group even if patients have the same type and stage of cancer.
• So why are cancer centers not using this approach to treatment? It is very difficult for large structured institutions and pharmaceutical companies to move quickly with the world’s modern technologies because they have so much invested in the old system.
• The doctors at Envita noted that when patients were tested, over 75% of them were on the wrong treatments prior to coming to the center. No wonder so many patients are struggling with cancer!

The war on cancer

Back home in Malaysia, this is what Dr. Amir Farid Ishak wrote in his Star column. http://thestar.com.my/health/story.asp?file=/2012/10/28/health/12226744&sec=health 

• Chemotherapy is not necessarily the best strategy to fight cancer.
• In several previous articles, I quoted several major reviews on chemotherapy, reported in the top peer-reviewed journals that concluded that chemotherapy only helped 2-7% of the cancer patients, at the cost of so much additional suffering, and enormous financial burden.
• Oncologists and the medical community in general continue to believe that chemotherapy protocols should be continued despite the overwhelming scientific evidence to the contrary.
• They then convince cancer patients that chemotherapy is essential if they hope to prolong their lives or recover from the disease. Yet, the scientific studies show that what is believed by the oncologists is not always the same as what is proven by the studies.
• The most recent comprehensive review of the effectiveness of chemotherapy was published by three oncologists in 2004 in the top cancer journal Clinical Oncology (16:549-560), and the conclusion was that overall, chemotherapy contributes just over 2% to improved survival in all the cancer patients in Australia and the US.
• In 2004, most of the other oncologists neither refuted nor changed their reliance on chemotherapy despite the conclusive evidence. Now eight years later, although no similar comprehensive review has shown any significant improvement, that review is said to be outdated by some oncologists.
• What I lament is the painfully slow progress in cancer therapy, such that many are not saved. The US is arguably the most advanced nation medically, yet for 2012, the American Cancer Society expects almost 600,000 deaths from all types of cancer (including 160,000 from lung cancer, 50,000 from colorectal cancer, and 40,000 from breast cancer). One in four deaths in the US is due to cancer. There will be about 1.6 million new cancer cases this year. Those figures certainly show that we are far, far away from winning the war on cancer.
• Have we won the war? Or have we the lost war?
• I strongly encourage readers to read War on Cancer – A Progress Report for Skeptics (Feb 2010) by Dr Reynold Spector, clinical professor of medicine at the Robert Wood Johnson Medical School, US (www.csicop.org/si/show/war_on_cancer_a_progress_report_for_skeptics/). His conclusion: “… unlike the successes against heart disease and stroke, the war on cancer, after almost 40 years, must be deemed a failure with a few notable exceptions.”
• While the oncologists continue to look for the latest chemo and smart drugs, it is my duty to highlight the fact that while the next promising drug will be amply funded to prove its effectiveness, the next promising nutritional therapy is likely to be abandoned because nobody wants to spend money on something that cannot be patented in order to recoup the costs, as well as make a handsome profit.

Comments

For the past 16 years, we at CA Care have been spreading the above message. Now, I am glad to say that cancer experts in the US are saying the same thing. I don’t think I have to add any more messages!  But let me just share with you our frustrations over these years.

1. Almost all cancer patients who came to us have undergone all medical treatments. Most of them are “medically written off.”
2. And 70 percent of them come expecting us to cure them – they are seeking the elusive magic bullet. There is nothing wrong with wanting to find hope or not giving up hope, except that they are also the kiasu (only want to win) type . For this group of people, we would rather they go and find help elsewhere.
3. The kiasus want healing on their own terms.  They only want to hear what they want to hear. They want things easy and cheap. Boiling the herbs to help themselves is a big chore to handle. They don’t want to take responsibility for their own well being. They want a cure but they want to eat anything they like.
4. Only 30 percent of those who come benefit from our therapy.  They know what they are up against after being told the truth. They are determined to heal themselves and are willing to try. I have great respect and admiration for such patients.
5. We are fully aware that patients come here to find hope. And telling them that they don’t have any more hope is a disaster. So we know we need to strike a balance. Correct, we cannot cure your cancer, because I believe that no one on earth can cure cancer either! That is the reality. My auntie had cancer. She had surgery and radiation. She thought she was cured. Thirteen years later, the cancer recurred in her lungs and she died. Where is the cure? And do I need to hide that reality to cancer patients?
6.  Make no mistake, I don’t want to mislead them or cheat them. But by telling patients this, do I deprive them of hope? Yes or No, depending whether you are a kiasu or not! If you are the one who only want to win and would not want to lose, you would not like what I say. You don’t want to face reality.
7. By telling you the truth – that I cannot cure you, does not mean that you are going to die now! If you have been reading the stories in our CA Care’s website, you will note that those patients were told to go home and die, but they do not die. They continue to live! That is hope! At CA Care we have seen miraculous healing week after week and month after month. But, make no mistake, this healing is NOT cure – the cancer can come back again if you become complacent and irresponsible.  But the unfortunate part is that many patients are just irresponsible. Period.
8. So, by being honest and asking you to face reality we are not depriving you of that hope – on the contrary we provide you with new path and take you through another journey of hope.  The only problem is this – the journey is not easy to travel and is not meant for the kiasu.  I have enough documented stories to show you that you need not have to die yet if you are prepared to take the responsibility of your own healing into your own hands – you do your best and we do our best. And together we take this journey. Many remain healthy for years. Click on the success stories of our cancer patients and hear them tell you their stories. Just one example –  I like to tell you the story of this sweet lady from Makassar. https://cancercaremalaysia.com/2012/05/05/cervical-cancer-stage-3b-health-restored-after-taking-herbs-and-giving-up-chemo-radiation-treatments/
9. The kiasus like to hear only things that they want to hear. For example:
   1. Cancer can be treated! Many patients don’t realize that to be treated is one thing. To get cured is another. While writing this article, I have a lady who came for help. She brought her sister for treatment in a private hospital  here and had already spent RM 100,000. A few hours ago, the doctor told the sister to bring the patient home quickly. She was not getting any better – in fact her health had deteriorated. Cancer can be treated for a long as you have the money to pay the bills (and preferable if you have a fat health insurance coverage!)  Read my articles: Part 1: The High Cost of Staying Alive in a Private Hospital. Part 2: One or Two Dozens of Drugs A Day Could Not Help Her?
   2. With chemo, you have a 80% chance of curing your lymphoma!  Patients love to hear that message of hope. And they believe such statistics!  Here is one example. A lady with cervical cancer was told that she had a 98 percent chance of cure with chemotherapy and radiotherapy. She believed her doctor. Four months later the cancer spread to her lungs. And that is cure? I hear this kind of stories very often. https://cancercaremalaysia.com/2012/05/02/cervical-cancer-eighty-nine-percent-chance-of-cure-vanished-with-the-collapse-of-her-right-lung-four-months-after-radiotherapy-and-chemotherapy/

Here is another example. A breast cancer lady underwent chemotherapy, radiotherapy and took Tamoxifen for five years.  Then cancer spread to her bones. She asked the doctor why she was not cured. The answer was:  It is your fate.  But the recurrence has nothing to do with what you eat. It is just your fate. Believe that? Where is the so-called science in cancer treatment? https://cancercaremalaysia.com/2012/05/12/breast-cancer-when-a-so-called-cure-was-not-a-cure/

Let me end with these quotations:

Take note, the author, Dr. Dan E. Chestnut, is a medical doctor of 44 years.