Is oncology as we know it sustainable?

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In the first part of my assignment, looking at oncology as a patient, I discovered a very inconvenient truth: the  increased survival rate after 5 years from the very expensive and toxic to life conventional cancer therapies is only 2.3%.

In this series of posts I last looked from a frustrated oncologists’ viewpoint.

I uncovered possibly good grounds for refusing all orthodox interventions to look to lifestyle factors (which CAM providers generally try to get patients to do).

I start this week with healthy living and prevention – either to avoid the process of initial cancer, or at the end after any orthodox attempts at cancer eradication without looking to why it is there, and what would bring it back on line.  http://www.who.int/cancer/prevention/en/

To fund any form of treatment without addressing the cause of the condition is possibly a case of living in denial, remarkably shortsighted and altogether too expensive.

If the patient continues to live the life that gave them the cancer, is it not likely to reappear?

In the 11th Annual Research Conference on Diet, Nutrition and Cancer, Go, Wong and Butrum produced a paper that is freely available in PDF http://jn.nutrition.org/content/131/11/3121S

From the abstract it states:

‘A new paradigm for diet, nutrition and cancer prevention can be developed using multidisciplinary approaches that include lifestyle and environmental changes, dietary modifications and physical activity consciousness to reduce the burden of cancer not only for high risk individuals but for the general population as well’.

CAM providers and the various alternative cancer strategies all are based upon this approach.

As I have mentioned last week, in a straw poll of patients who have recovered from cancer after orthodox treatment NONE of them were told what to do to reduce their chances of cancer returning.

This is no doubt why so many in the Crystal et al (2003) 49 % of cancer patients are utilising CAM, and why so many were not bothering to mention what else they were doing to the oncologists, as prevention, and healthy living is outside their apparent scope of practice.

To look to funding more conventional (and highly lucrative for pharmaceutical companies in the fee-for-service based ‘health’ industry) toxic attacks on a body whilst there is evidence that the cancer was grown through inattention to basic healthy life choices seems to be remarkably expensive and illogical.

From the Go, Wong and Butrum document above:

“For the past century, our current nutrition research paradigm has been based on identifying a single nutrient in a deficiency state and the role of particular single nutrients in cell growth and development of an organism as well as investigating their roles in the intermediary metabolism pathways.”

This to me shows that a new research model that is not made for drugs to be passed into the population needs following for real life.

They further state:

“Our current knowledge points to the idea that diet contains multiple biologically active compounds and nutrients and non nutritive compounds that can affect gene expression and have different bio-availability profiles and can be converted into isomers and metabolites of different potency, which lead to complex beneficial interactions. This provides justification for us to create a new research paradigm in determining and investigating the diet in health promotion and disease prevention approaches, including cancer.”

Possibly studying populations that do not get cancer would show then that it is a lifestyle choice to get cancer at all.

Researching online for this discussion, I found http://www.theaustralian.com.au/news/nation/alcohol-blamed-for-cancers/story-e6frg6nf-1226048008362

Finding alcohol was classed as a Class 1 carcinogen since 1988 was a huge surprise – why is it allowed to still be sold in shops where food is sold?

Whilst in the First World we are eating, drinking and smoking ourselves into the cancer pit, we seem also to be wasting public resources and personal lives through unaccountable idiocy. http://www.asianscientist.com/health-medicine/cancer-environment-lifestyle-factors-2012/

Coincidentally last night I was looking through the online newspapers:

http://www.theage.com.au/national/diet-or-die-lifestyle-changes-could-hit-cancer-20120318-1vdm9.html

Going back to clean living may not suit the average modern person.

What price their modern lifestyle?  As you have stated, people are aging, cancer is an aging disease – and when ill, working for money is out of the question.

This problem of cancer blowing out all budgets is increasing. This could get into the ethical arguments of self care – why give treatment to someone who is still creating the problem?  Can the average person change their quality of life?  Especially stop living in fear of getting it again’ through taking charge of what will enhance their risks and avoiding them?
http://www.adelaidenow.com.au/small-changes-to-avert-cancer-risk/story-e6frea6u-1226218553177

I will ponder the costs of not following basic health care ideals as they apply to the process of getting stuck in the wheels within the cancer machinery as the week progresses.

References

  • Chrystal, K., Allan, S., Forgeson, G., & Isaacs, R. (2003). The use of complementary/alternative medicine by cancer patients in a New Zealand regional cancer treatment centre. The New Zealand Medical Journal, 116 (1168), U296. URL: http://www.ncbi.nlm.nih.gov/pubmed/12601420

(all sourced 19/3/12):

To begin discussing the use of CAM in cancer treatment from the funder’s perspective I think it is important to acknowledge some philosophical differences that exist between an individual perspective and the public health perspective.

What may be important for a clinician or for an individual patient may not be relevant to a funder. While we (as clinicians or individuals) may consider that quality of life (QoL), and survival rates are important, from a funding perspective, the disability-adjusted life year (DALY) may be a more important factor to consider.

By way of definition  – what is a DALY

“extends the concept of potential years of life lost due to premature death to include equivalent years of “healthy” life lost by virtue of being in states of poor health or disability. One DALY can be thought of as one lost year of “healthy” life, and the burden of disease can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age, free of disease and disability.”(WHO, 2008)

Why is this important to the funder? Given that funding comes primarily from government (at least in NZ), a major concern form health funding is its impact on the economy. Calculating DALYs and how intervention can affect them is an important consideration.

It has been said that the definition of a cynic is someone ‘who knows the cost of everything and the value of nothing’. However if we accept that the financial pool is limited, this is a very pragmatic and just approach to funding health services. Every health dollar spent should (from this perspective) be balanced against net gains of healthy (and thus ‘productive’ life).

As we know, cancer is a massive and growing problem and New Zealand has the 4th highest incidence of cancer in the world (“World Cancer Research Fund,”).

Finances are clearly strained and adding another therapy into the mix merely to improve QoL would be a highly questionable allocation of taxpayer dollars. Even with just the current treatment regimen

“Based on estimated mean costs of registered cancers in 2008 (2008/09 prices) and incidence projections from 2011 to 2021… the price of cancer will increase by $116.8 million (23% of $511.5 million) in 10 years.”(Health, 2011).

As a funder, I am not really interested in how CAM impacts an individual and it seems very unlikely that CAM could be incorporated into conventional treatment for any other reason than it might significantly decrease DALYs of cancer patients. Bearing in mind that a DALY is calculated and weighted according to age (see attached chart), this would guide where research spending is directed.

The fact remains however harsh it may seem, that expensive cancer treatment in the aging population is not fiscally responsible. If funding is directed at CAM in cancer, selective research according the greatest potential saving of public money should be borne in mind.

The use of CAM in cancer prevention could be one possible area of research. Perhaps this is one of the greatest strengths of CAM and as far as research goes, much is yet to be uncovered.

I believe there is also a very strong case for not viewing departmental budgets in isolation. I understand that from an administrative point of view this maybe the most workable model, but long term this reductionist approach probably doesn’t meet the greater good.

If we viewed transport spending as inclusive with health spending for example, much could be saved in health by providing more cycle lanes (improved cardiovascular fitness from more people cycling, reduced toxic fumes from less vehicles, reduced stress levels from increased exercise etc. etc…) even though there was slightly more spending in transport for the short term, the net effect would be financial gain.

Viewing CAM within a wider social context and its wider effects maybe an appropriate area of research.

References:

The unprecedented demographic trends mean the old-age dependency ratio – the ratio of people aged 65 and older relative to the working-age population aged 15 to 64 – rises from 19% in 2009 to 42% in 2050.
The following table shows that the ratio of people 65 and older to those between 15 and 64 more than doubled in the 100 years to 2000, and will do so again in the next 50 years.
Table 4.1 – People 65 and older for every 100 aged between 15 and 64
•
Source: Statistics New Zealand
These population shifts in New Zealand are already underway. But they are about to accelerate, with the first baby boomers retiring in 2011; most of the change in the population will occur over the next 20 years.
Though there are savings to be had in the health system please refer to the above table for the growth of the elderly population, whilst the younger tax paying population will be decreasing in number. Perhaps the most important financial figures to focus on are the median household income levels of the typical New Zealand household. This will give any healthcare provider a good sense of what they can offer in terms of CAM cancer care.

World cancer statistics: Overall

http://www.wcrf-uk.org/research/cancer_statistics/world_cancer_statistics_overall.php

This section lists the 50 countries with the highest overall cancer rates in the world.

Denmark has the highest rate in the world. The UK has the 22nd highest cancer rate and every year 266.9 out of every 100,000 people in the UK develop the disease.

Scientists estimate about a third of the most common cancers in the UK could be prevented though diet, physical activity and weight.

Rank Country Cases per 100,000 people
1 Denmark 326.1
2 Ireland 317.0
3 Australia 314.1
4 New Zealand 309.2
5 Belgium 306.8
6 France (Metropolitan) 300.4
7 USA 300.2
8 Norway 299.1
9 Canada 296.6
10 Czech Republic 295.0
11 Israel 288.3
12 The Netherlands 286.8
13 Luxembourg 284.0
14 Hungary 282.9
15 Iceland 282.2
16 Germany 282.1
17 Uruguay 280.3
18 Italy 274.3
19 French Polynesia 269.6
20 Switzerland 269.3
21 Slovenia 267.9
22 UK 266.9
23 Croatia 263.1
24 Republic of Korea 262.4
25 Slovakia 260.6
26 Sweden 252.1
27 Finland 249.8
28 Lithuania 244.4
29 Chinese Taipei 244.1
30 Mongolia 242.2
31 Spain 241.4
32 France (Martinique) 234.9
33 Austria 232.7
34 Estonia 230.4
34 Latvia 230.4
36 FYR Macedonia 225.1
37 Bulgaria 224.7
38 Portugal 223.2
39 Poland 222.9
40 Serbia 218.9
41 New Caledonia 218.5
42 Belarus 213.1
43 Malta 211.4
44 Barbados 207.9
45 Armenia 207.5
46 Argentina 206.2
47 Romania 205.1
48 Montenegro 204.3
49 Albania 202.8
50 South African Republic 202.0

All estimates and names of countries and which territories constitute counties are from GLOBOCANversion 1.2 December 2010, a World Health Organization project. All cancer rates are adjusted for age and are expressed per 100,000 people.

  • Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr