Comment by roadside_picnic
18 hours ago
An eye opener for me was when a friend of my was dying of cancer there was a period where he got sepsis, ultimately because of the effects of chemotherapy not directly because of the cancer. But had he passed from sepsis (he survived that incident), the cause of death would ultimately be attributed to cancer and not chemotherapy.
I looked into it deeper at the time and it's very difficult to untangle the true cause of death in many of these situations. While certainly these treatments are ultimately beneficial statistically, it is concerning that there's not as much discussion around their harm and the real risk rewards behind various treatments. I know from my own (non-cancer) experience that there is a very strong bias towards treatment even in cases where, once you break down all the risk and rewards, there is a strong argument for non-intervention.
I suspect the medical industry is so heavily regulated that it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion, though maybe it depends on the country.
Here in Canada, before assisted suicide was legalized, my grandfather (in his late 80s) refused any treatment for his kidney failure. He was ready to die and could barely walk or eat on his own anymore. There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal. The death certificate still said renal failure, though.
For me, if I ever got terminal cancer, I'd weigh the quality of life of treatment versus non-treatment. I've seen people go both ways and I've seen the results being right and wrong both ways. I don't want to spend my final months semi-alive on a bed or constantly messed up, though.
> it is very difficult for doctors to recommend non-treatment or risk being sued into oblivion
Not my experience. I have a loved one going through cancer treatment right now and they've been very up front about risks, side effects, and even talked about DNRs with them what they mean and how they can be applied.
People and their loved ones don't want to experience death. It's often as simple as that.
> There was a wink wink situation where as the kidney failure worsened, his morphine was increased to the point where it was fatal.
In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
> I'd weigh the quality of life of treatment versus non-treatment.
Something to consider, it's not a binary and treatment can look entirely different depending on the cancer.
You can, for example, do a lower than effective dose of chemo which will still be effective at slowing the growth of cancer.
Some therapies, such as immunotherapy, can be practically a walk in the park.
I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
> People and their loved ones don't want to experience death. It's often as simple as that.
People also don't want (their loved ones) to suffer, especially needlessly. (I want to also stress that I'm not advocating terminating life, though I do think it should be an option - just that this is what my grandfather wanted).
> In the US, exactly because of situations like this, that sort of thing is a lot harder today to pull off.
I've anecdotally heard that a huge percentage of US medicare costs is desperately saving elderly people at the end-stages of life instead of a more palliative (and some would argue dignified) end. This was made worse during the Terri Schiavo case when the very idea was put up as anti-life and we were warned that "death panels" would be inevitably setup. DNRs are allowed, but alleviating the suffering leading up to the end is, for both better and worse, heavily restricted.
> I'd suggest strongly in any case that you have a discussion with an oncologist if you ever get to that point. Things in medicine aren't nearly as black and white as people sometimes assume.
I've been extremely lucky that cancer hasn't been much of an experience I've had to deal with in my circles. I'm mostly pro-modern medicine and I know a lot of progress is also being made. I hope that it never happens, but if it did I'd want to be informed as possible to make my own decisions. The decisions I'd make depend so much on where I'm at. I'd be likely more willing to risk it now as I have a 7 year old to live for, than I would be in my 90s where the odds are a lot less for a comfortable experience.
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Chemotherapy is essentially a bet that the drugs will kill the cancer faster than you. Because ultimately, cancer isn't a virus, bacteria, fungus, parasite, nor even a prion (this one is nightmare fuel) -- it's your own cells acting as a parasite. This reason alone makes cancer horrific to treat as it is.
There are multiple types of chemo. There's not just 1 chemo drug and how it looks can be all over the board.
Sort of at the opposite end, I knew a PT who harped on balance exercises and pointed out that a lot of old people have pneumonia as cause of death on their death certificate. The pneumonia was often acquired while immobilized by a broken hip. The broken hip was caused by falling (+ lower body atrophy), so really these people died from falling. It just took a while.
I don’t know what the right answer is for coding death certificates. Maybe the correct answer is to record several so we can see comorbidities and contributing factors more easily when deciding what science to fund, charities to endow, and which treatments to disfavor.
Died of complications of cancer, reaction to chemo. Died of complications of hip fracture, pneumonia.
A relative of mine was dying of stage 4 lung cancer and after they were admitted to the hospital, they contracted COVID and passed away two weeks later.
Their life expectancy upon admission was estimated to be less than a year, so it's hard to pin this on just the pandemic.
Personally I would put "smoking" in the form, because truth be told that was the single largest contributing factor.
I have friends and relatives who went through this process and what I believe is not repeated enough to the patient's immediate social circle is that the recovery process takes months and the procedure itself can leave lasting changes.
What's crazy is that this used to be much worse, but advancements in targeting and new treatments improved things quite a bit.
No one gets paid for non-intervention.