Sen. Kennedy Given Painful, Futile and Expensive Cancer Therapy

In May of 2008, we learned that Senator Edward Kennedy had brain cancer. We were told by CNN and other news outlets that: After a seizure caused him to collapse in May 2008, Kennedy underwent a 3½-hour operation at Duke University Medical Center in Durham, North Carolina, to remove a malignant tumor from his brain. Surgeons reported the surgery was a success and that Kennedy should suffer no permanent damage from the procedure. See more on malignant brain tumors » Kennedy's follow-up treatment plan was to include radiation and chemotherapy. Source: cnn.com This was falsely reassuring. Kennedy was suffering from a "glioma,", a type of brain cancer normally has a "grim prognosis," with or without brain surgery and chemotherapy. A seizure is often the first symptoms of the "glioma" type cancer that took Kennedy's life. In January of this year, Reuters reported, Sen. Edward Kennedy, who is battling brain cancer, was recovering at a Washington hospital on Tuesday after suffering a seizure at an inaugural lunch for President Barack Obama. Source: reuters.com Upon announcing Senator Kennedy's death today, the New York Times reports, Mr. Kennedy had been in precarious health since he suffered a seizure in May 2008. His doctors determined the cause had been a malignant glioma, a brain tumor that often carries a grim prognosis. As he underwent cancer treatment . . . Source: nytimes.com

Nonetheless, doctors performed various medical procedures on him in what they knew was a vain attempt to save his life. The likelihood is that the treatment he received significantly increased his discomfort on the way to a predetermined death, and one that will be felt deeply around the country.

One study, "Malignant cerebral glioma--I: Survival, disability, and morbidity after radiotherapy", says:

Malignant glioma is the most common primary brain tumour in adults. It generally presents with epilepsy, cognitive change, headache, dysphasia, or progressive hemiparesis.

The issue that arises is, "What is the point of the cancer chemotherapy therapy when doctors know the cancer cannot be cured; the chemotherapy will hardly prolong life if at all; the patient will experience as much stress and pain from the treatment as from the cancer itself; and the medical resouNonetheless, doctors performed various medical procedures on him in what they knew was a vain attempt to save his life. The likelihood is that the treatment he received significantly increased his discomfort on the way to a predetermined death, and one that will be felt deeply around the country.

The same study says,

Diagnosis is usually achieved by appropriate imaging studies (figs 1 and 2) followed by biopsy or surgery.2 3 A randomised trial shows that the median survival after surgery for patients on steroids alone is only 14 weeks compared with 38 weeks after radiotherapy.4 The two year survival after treatment is only 5-10%.5 6 Although radiotherapy to the brain prolongs life, neurologists and others remain uneasy about the trade off between survival and quality of life.7 89 For most patients, even after treatment, increasing disability and death occur by one year. Furthermore an economic appraisal has shown that the cost of achieving one quality adjusted life year (QALY) is over £100 000.1011

Various newspapers now report that Senator Kennedy has died after "battling" and "fighting" brain cancer, but there is something wrong with the battleground metaphors in case where cancer is inevitably and shortly going to take the victim's life:

The treatment the senator received appears to have extended his life, bestowing precious additional months to spend with his family and to witness glimmers of the health care overhaul he so fervently sought. “From the patient’s point of view, that year is invaluable,’’ said Dr. Keith L. Black, chairman of neurosurgery at Cedars-Sinai Medical Center in Los Angeles. “People can live a lifetime in that year.’’

But, in the end, brain cancer - an implacable, insidious foe - claimed another victim, despite all the privilege and power the senator could bring to the fight. From the frightening seizure in Hyannis Port last year that heralded the tumor’s existence, to the senator’s death yesterday, months had passed, a period that mirrors the average life expectancy after diagnosis.

Source: boston.com

Having seen the battle against terminal cancer from up close, I have reason to doubt that the extra months added to a life are worth the months spent recovering from invasive surgery and chemotherapy.

In light of the harm done to the cancer patient by the outrageously expensive medical interventions, might the money not be spent more prudently on patients whose medical attention really will extend the length, vitality and productivity of their lives?

It is perhaps at this point that the greatest ethical and moral challenges arise.  Should a medical system on which all of us depend encourage patients to spend $200,000 for an additional month or two of life, when that time will be spent, in any case, battling the dehumanizing effects of chemotherapy.

Knowing what we do about the effects of chemotherapy, how many of us would undergo four month of chemotherapy in order to extend our lives by four months?