Khatcheressian and coauthors’ article about futile care in oncology addressed an important but uncommonly discussed aspect of oncology.[1] There are several other points that were not brought up in the excellent discussion.
First, regarding hospices and palliative care, services offered by community hospices vary considerably. Some hospices offer a full range of services including inpatient support, access to pain specialists, and occasional blood transfusions when appropriate. Others offer a mere baseline of care, which leads to patients and families feeling abandoned, sometimes resorting to emergency room visits so that their loved ones can have their needs properly addressed.
With the growth of the Internet and the abundance of drug company advertising, patients and their advocates have access to a wide variety of confusing and sometimes misleading data. Similarly, the growth of health science journalism, particularly broadcast journalism, which often touts new technologies and treatments, often is more reflective of press releases generated by drug companies and tertiary referral centers than true interpretive or investigative journalism. For example, the difference between targeted therapy for diseases like chronic myeloid leukemia and gastrointestinal stromal sarcomas (which may in fact provide long-term disease stabilization and possibly cure) and targeted therapy for disseminated solid tumors (which may extend survival but do not provide cure) is not readily apparent to the layperson.
Lack of unity among oncologists regarding futility of care is perhaps the largest problem. Patients and family members often seek an oncologist who will “do something,” and this is usually interpreted to mean giving chemotherapy. Dealing with daunting odds is part of being an oncologist, and unfortunately, the search for palliation can lead to wishful thinking on the part of all involved with patient care.
Russell Gollard, MD
Henderson, Nevada
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
