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There is one serious problem in your analysis. Early detection picks up very small tumors. Many would never become a threat. Others would have taken more than five years to become harmful. So if you start the five years running with "diagnosis" that includes removal of the very small tumor during a colonoscopy or as a result of a breast examination or mammogram. An awful lot of that improvement is thus phony.
There is no way that someone who has a borderline polyp removed should be counted in the five year statistics.
Statistics are also tracked by stage for various cancers. For most, early diagnosis means better prognosis. For some, such as pancreatic cancer, there is no screening test and by the time symptoms appear the cancer is usually advanced.
For Mr. Carter, the site of the original melanoma is unknown, for example.
For breast cancer, smaller tumor size explains only part of the improvement in outcome:
Unless a colon polyp was actually malignant it would not be counted in any cancer statistics. Removal of polyps that have not yet become cancerous does reduce the incidence of colon cancer.
My grandfather was diagnosed with Stage 4 pancreatic cancer when he was 80 years old. Beyond that deadly diagnosis, he was in very good health. He walked several miles every day, was involved in running a family business, and had extensive community and family activities going, all the time. He was a busy man, and he was not ready to die. When he was told that he had no more than two months, tops, he was severely depressed. This despite being a person of faith, who believed he'd be going to heaven.
My family took him to Mayo for a second opinion. The diagnosis was quickly confirmed, but he was invited to participate in some clinical trials for a new drug. He jumped at the chance. I remember hearing about his reaction, how he asked if he'd maybe make it to the next spring, to be able to see my cousin get married, meet my sister's new baby who was due in 7 months.
The treatment was successful in buying him 18 more good months. He danced at my cousin's wedding, played with his new granddaughter. It started coming back after that. He made it to my wedding, but barely. He sat and watched and smiled, left the party early to rest. He died 3 months later in horrible pain, almost exactly two years after he'd but that would have happened even if he hadn't fought.
I would always support somebody who wanted to attempt treatment, regardless of age. When my grandfather was being treated for pancreatic cancer, he developed glaucoma. One of his doctors expressed some doubt as to whether it was worth it, to have surgery, considering his age and cancer. But at that time, he was doing well, and as he said, if he only had a year left in his life, he'd like to be able to see it. So they did, and he recovered well from that surgery and lived another 18 months. If somebody is tired and doesn't want to pursue it any more, fine. My 94-year old grandmother is now at that point. But, age is more than just a number.
So a doctor won't force you to get mammograms and pap smears, he'll just refuse to keep you on as a patient if you don't? What's the difference? LOL
You are still not "forced" to have a test you do not want. You do know that failure to diagnose breast cancer is a big source of malpractice suits, I presume? The very woman who refuses the mammogram is the one who will come back when she is found to have an advanced cancer and allege that if she had only been properly counseled she would have had the test done.
I'm sure it wouldn't be hard to prove via office visit notes that the patient refused the tests; I'd happily sign a waiver, personally. But for a doctor to "fire" a patient for this reason -- esp. when other doctors aren't accepting new patients -- seems to me to be controlling and coercive in the extreme. Ultimately, it's the patient's life and body and should be the patient's choice.
I'm sure it wouldn't be hard to prove via office visit notes that the patient refused the tests; I'd happily sign a waiver, personally. But for a doctor to "fire" a patient for this reason -- esp. when other doctors aren't accepting new patients -- seems to me to be controlling and coercive in the extreme. Ultimately, it's the patient's life and body and should be the patient's choice.
Such "waivers" are worthless. The patient can still claim lack of informed refusal.
Doctors have a choice as to which patients they will see, too. Why should any doctor want to take care of a patient who does not respect the doctor's expertise?
Nobody's "forced" to do anything generally unless the person with power of attorney is misusing their power.
My grandmother was diagnosed with stage 4 lung cancer at 88 after being in declining health for a few months (she had been very active up until then). She had one surgery to help improve her quality of life and then fell and broke her hip and arm. While she was heavily sedated, one of her doctors raised the possibility of keeping her sedated until she passed rather than putting her through another surgery.
My entire family (including me - and I'm a big supporter of euthanasia) was furious that this idea was even raised for a number of reasons, but primarily:
1) She was lucid and upbeat despite her pain levels, even flirting with the male hospital staff.
2) She very clearly wanted to pursue treatment and had been very explicit about that.
She had the surgery, and as expected had difficulty recovering almost immediately. However, after the surgery, she was able to avoid the more extreme pain killers and returned to a very high level of mental sharpness. Over the next two weeks she was on and off a ventilator, but she got to see almost every one of her friends and relatives. She was happy and upbeat until her last 24 hours when she simply slid into a coma. It was a really good death in so many ways. Yeah, she was on medicare, so the cost to the taxpayers was probably pretty big, but I think the focus of end-of-life care should be on providing the death the patient wants, not the most cost-efficient or the most rigorous treatment.
Frankly, I was glad she went out this way rather than sticking around and risking the cancer spreading or having her lungs slowly fail her.
Jimmy Carter is a very healthy man for his age with a very rewarding life. Depending on how he reacts to the treatments, he could have several high-quality months before going into a decline. With terminal cancers like this, you really don't know what will happen until you give it a try.
Nobody's "forced" to do anything generally unless the person with power of attorney is misusing their power.
My grandmother was diagnosed with stage 4 lung cancer at 88 after being in declining health for a few months (she had been very active up until then). She had one surgery to help improve her quality of life and then fell and broke her hip and arm. While she was heavily sedated, one of her doctors raised the possibility of keeping her sedated until she passed rather than putting her through another surgery.
My entire family (including me - and I'm a big supporter of euthanasia) was furious that this idea was even raised for a number of reasons, but primarily:
1) She was lucid and upbeat despite her pain levels, even flirting with the male hospital staff.
2) She very clearly wanted to pursue treatment and had been very explicit about that.
She had the surgery, and as expected had difficulty recovering almost immediately. However, after the surgery, she was able to avoid the more extreme pain killers and returned to a very high level of mental sharpness. Over the next two weeks she was on and off a ventilator, but she got to see almost every one of her friends and relatives. She was happy and upbeat until her last 24 hours when she simply slid into a coma. It was a really good death in so many ways. Yeah, she was on medicare, so the cost to the taxpayers was probably pretty big, but I think the focus of end-of-life care should be on providing the death the patient wants, not the most cost-efficient or the most rigorous treatment.
Frankly, I was glad she went out this way rather than sticking around and risking the cancer spreading or having her lungs slowly fail her.
Jimmy Carter is a very healthy man for his age with a very rewarding life. Depending on how he reacts to the treatments, he could have several high-quality months before going into a decline. With terminal cancers like this, you really don't know what will happen until you give it a try.
Also, the chemo drug he is taking may give him more than a few months.
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