The Prognosis: You Know the Diagnosis, Now What?

July 11, 2012

The brave new world of cancer treatment – and prognostic information – was featured in the New York Times: “A Life-Death Predictor Adds to a Cancer’s Strain.” This is notable not only for the novel medical treatment but also for the revelation of practicing physicians’ ethics and the way in which new treatments are promoted.

First, note that one study, notwithstanding the degree of its rigor, and when conducted by those who profit from a particular outcome, is not sufficient nor objective enough to reflect good evidence-based medicine. It remains squarely within the realm of experimental treatment and certainly does not merit the claim that “[n]o test has ever been so accurate in predicting cancer outcomes.”

Also, I see no mention of whether this genetic test or the specialists’ evaluations can determine if the tumor has already metastasized. Of course, if it has, even if the tumor lies within the more benign category, the patient’s prognosis is quite different.

The second ethical quandary: Dr. Harbour is dangerously close to violating his ethical obligation of Informed Consent (see) when making judgment calls as to what his patients can “handle.” Better to first ask his patient how much they want to know.Dr. Gragoudas’ policy better conforms with the substantive meaning of the doctrine, which includes imparting the financial, emotional and physical costs of alternatives.

As a patient advocate, my clients tend to want full disclosure of their likely prognoses as well as knowing the validity and extent of available information to date, treatment options, and the risk/benefit of alternative decisions.

Last, I note that Dr. Harbour’s method clearly involves more expense than that of Dr. Gragoudas. Is Dr. Harbour’s methodology tainted by profit motive?

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