Quora Question: Does the U.S. Provide Superior Cancer Treatment?

Cancer treatment
A breast cancer patient receives a chemotherapy drip, North Carolina, June 17, 2003. Chris Hondros/Getty

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Answer from David Chan, MD from UCLA, Stanford oncology fellowship:

The United States has better cancer survival statistics compared to most other countries. Whether this is simply because of better cancer treatment is arguable.

A missed cancer diagnosis is a common lawsuit in America. The defendants typically settle for unlimited economic loss and also pain and suffering. That is a huge incentive for American doctors to over-test for cancer. Of course that leads to earlier diagnosis and a significant time bias in studies comparing healthcare systems.

In my opinion, American cancer patients are over-treated compared to those in other countries. Almost every patient has some kind of treatment in the general panic of learning of their diagnosis. Too many American cancer patients have surgery that may not lead to better survival such as a large group of men with low grade prostate cancer or women with low grade precancers of the breast (DCIS).

Many breast cancer patients in America receive chemotherapy and/or endocrine therapy for small cancers that would be treated without those treatments in other countries. Sometimes the benefit in treating is an additional 1 to 2 percent.

Americans favor high tech in everything. There is too much testing with PET and CT without regard to radiation risks over time. There was a rapid move to expensive robotic surgeries with subsequent studies showing marginal or no improvement in results, or in some cases even higher complication rates.

Having taken care of and having shared patients with other oncologists in Canada, the EU, Japan, Hong Kong, and Singapore, I’m impressed that whatever skill and technology American physicians have, it exists in many other industrialized countries.

So with all of that said, yes, America has among the best cancer survival statistics because of an incredible abundance of high technology equipment and drugs, more extensive screening and more aggressive treatment.

America also in general has better survival statistics when cancers are compared stage for stage. Of course there are exceptions. Japan survival statistics for stomach cancer are much better than American numbers.

Very expensive cancer treatments such as the new immunotherapies for cancer are more widely available in America than in countries with national healthcare where there are restrictions based on cost/benefit and budget caps.

The larger question is whether a society can afford to spend what America spends to get low single-digit improvement in cure rates and and to prolong survival by a few months especially at the end of life.

Treatments that cost $200,000 per year are used to extend average life expectancy by 3 to 4 months in stage 4 cancers. Of course it’s worth it for the minority of patients who are put into long term remission. But it doesn’t help the others.

Maybe we’ll get better as we develop molecular signatures to identity and target the patient most likely to benefit rather that broadly treating a large group of patients as is the current standard of care.

Sources:

Mortality rate due to cancer: Canada gets a “C” grade and ranks 13th out of 17 peer countries.

Colorectal cancer survival in the USA and Europe: a CONCORD high-resolution study

http://health.usnews.com/health-...

Cancer survival in England is improving – but still lagging behind similar countries

UK cancer survival rates trail 10 years behind other European countries

Is it true that the USA is better at cancer treatment than other countries? Or is this an artifact of the statistics? originally appeared on Quora—the place to gain and share knowledge, empowering people to learn from others and better understand the world. You can follow Quora on Twitter, Facebook, and Google+. More questions: