THREAD: This post engendered a lot of strong reactions, mostly positive and some negative. GOOD. If you read this and felt angry for being "called out", at least it got you thinking which was my goal. I thought you might want to hear why this is important. /1
In the USA 75% of lung cancer patients over the age of 65 (i.e. most pts) get NO TREATMENT for their cancer (Davidoff, JCO 2010, 28; 2191-97). This is despite treatment being less toxic and prolonging survival in many. The reasons for this are many, but a big one is NIHILISM /2
There is a strong perception among the public (i.e. patients) and among non-oncology medical professionals that lung cancer is a universally deadly disease with no good treatments and that people would be better off without bothering to treat it. This is misleading! /3
In fact while we may not cure advanced lung cancer (yet) we can help EVERYONE, even if only to palliate symptoms with meds or radiation. But treatments in 2018 for some (not all) are head and shoulders above what we used to offer and many pts live substantially longer /4
I've seen a doctor refuse to treat sepsis in a stage 4 NSCLC pt because it was "medically futile", on crizotinib with no active cancer, and after getting out of there and w treatment lived 2 years longer. I've seen pts referred to hospice who end up living yrs with treatment /5
In fact in a recent study in ALK+ NSCLC pts on crizotinib, the average (median) survival was 46 months. For EGFR mutant patients (15% of NSCLC) OS approaches 3 years, and for a recent PD-1 trial (KN 024, 30% of NSCLC pts) 30 months. Median means 50% of pts exceed these numbers /6
So for those who told me to stop blaming colleagues and "just communicate", that is what I am trying to do. Trying to remind everyone to communicate with an oncologist when a new lung cancer patient is diagnosed so that they can have a discussion of treatment options /7
And for the guy who told me "Hey some pts don't want treatment so referral is a waste of time", it's our job as doctors to make sure they know enough to make an educated decision and THEN let them decide (and yes no treatment is fine). OK I'm done now! /8
