Until more data on effectiveness of chemotherapy and other expensive treatments are available, the "watchful waiting" principle should be adopted. The outcomes following expensive treatments, in most cases, do not justify their use. Patients may feel expensive treatments are justified but the medical community needs to confront patients with scienftific data, regardless of the consequences.
Featured in NEJM Journal Watch: Cancer 2014 — A Modern Spin on a Tragic Diagnosis — Physician’s First Watch
Featured in NEJM Journal Watch: Cancer 2014 — A Modern Spin on a Tragic Diagnosis
By the NEJM Journal Watch Editors
In the Insights on Residency Training blog, Paul Bergl reflects on how complicated cancer has become for the generalist: "How do I craft my words to distinguish 'cancer' from 'pre-cancer'? What advice do I give to a patient with recent biopsy-proven, localized prostate cancer? Will I be sued for negligence [if] I didn't offer chemoprophylaxis for breast cancer in a patient who develops metastatic disease on my watch? How can I watch expensive third-line chemotherapy being given to one of my patients while another patient eats his way to a cancer-causing BMI of 40 on a low-cost, high-carb diet?"
With these thoughts in mind, he offers his take on what cancer means to the general practitioner in 2014.