by Nancy Meredith
When someone is diagnosed with lung cancer or mesothelioma, he is faced with an overwhelming number of decisions regarding treatment. While a doctor can provide a patient with the medical pros and cons of each treatment, ultimately it's up to the patient to decide whether to undergo treatment. According to the results of a recent study in Cancer, however, nearly 20 percent of U.S. cancer patients in stage IV of their disease are not receiving any medical treatment.
A team of researchers led by Alexander C. Small of Mount Sinai School of Medicine in New York City reviewed data of 773,233 patients with metastatic solid tumors who received neither radiotherapy nor systemic therapy between 2000 and 2008. The researchers found that 20.6 percent of those patients received no anti-cancer treatment.
Further review of the data revealed that fifty-five percent of the untreated population was made up of patients with non-small-cell lung cancer. The highest rates of non treatment were among kidney cancer patients (25.5 percent) and lung cancer patients (24 percent). The lowest rate of no treatment was seen for patients with prostate cancer (11.1 percent).
In the study, researchers identified several factors associated with no treatment across all cancer types: older age, black race, lack of medical insurance, and lower income. Although Small said, "Further studies are necessary to better define the reasons for this lack of treatment, particularly because these relate to access to care, health literacy, and treatment disparities."
What other factors might drive mesothelioma or lung cancer patients to decide not to treat their disease?
Pleural mesothelioma, a unique form of lung cancer caused by asbestos exposure, is highly aggressive and is resistant to many cancer treatments. Once the disease has reached an advanced stage, median survival is often less than one year. Chemotherapy and radiation are offered as palliative options for Stage IV cancer patients, but they may not offer relief to the patients. And for some, the side effects caused by the treatments leave them feeling worse than the disease itself.
The Mayo Clinic recommends setting ground rules when deciding on a cancer treatment. It suggests deciding up front what side effects you are willing to put up with and how the treatment will affect your daily life. Also, Mayo suggests you not allow yourself to be pressured into decisions that don't align with your personal desires. For late stage cancer patients, the Mayo Clinic says you might decide that comfort is most important to you. Based on this you can work with your doctor to help you be free of pain and other symptoms. This might not require treatment per se, but could include narcotics, for example, to help relieve pain.
After weighing all the treatment options, according to the Mayo Clinic, "some people choose not to have treatment at all." People with very advanced cancers sometimes find they'd rather treat the pain and other side effects of their cancer so that "they can make the best of the time they have remaining."
In the future, mesothelioma patients may have treatment options available to them with minimal side effects. Researchers in Australia, at Indiana University, at Duke University and at many other research sites, have all made breakthroughs that could lead to significant advances in mesothelioma treatment, and potentially, a cure for the disease.
It is important for mesothelioma patients to know that they are not alone when determining their best course of treatment. If you don't feel comfortable discussing options with your family, feel free to turn to a mesothelioma support group.
