U. S. cancer deaths have been declining since the 1990s. What, then, is there to talk about other than the good news in cancer prevention and treatment? August authors consider the ethical questions that clinical successes give rise to: extreme prices for drugs of marginal benefit; drug shortages that compel physicians to decide who receives preferred treatment, persistence of suboptimal care; the allure of experimental therapy when approved drugs fail; the ambiguous state of “survivorship”; and advances in whole genome sequencing that can reveal incidental information that patients (or patients’ families) may not want to know.
There is evidence that children who are unaware of their life-threatening diagnoses do not experience any less distress and anxiety than those who are told, and in some cases they may actually experience more.
Stories about courageous survivors abound. There is an odd impression in American society that cancer is a passing inconvenience for most, an opportunity for personal growth for all, and a badge of honor for those who “survive.”
Thomas W. LeBlanc, MD, MA and Amy P. Abernethy, MD, PhD
One strategy to promote adherence is the use of “care pathways,” effectively roadmaps that seek to standardize cancer treatment on the basis of some agreed-upon set of guidelines within a particular center or group of patients.