Quality, Rather Than Quantity, of Life Is the Crucial Criterion
This important article raises some critical comments and questions (1).
In recent years, oncologists (including myself) have often discussed the ethical meaningfulness of therapies; especially as regards patients’ quality of life in the area of conflict that is presented by therapies that often provide an only minimal increase in lifespan for the patient, with increasingly severe adverse effects.
Our ethical responsibility to protect patients from harm seems to have given way to an interpretation according to which only the minimal statistical value seems to matter.
What does even a few weeks’ response to treatment mean for a patient if they have to put up with severe side effects for their brief remaining lifespan?
The review article did not include any critical comments on this. Much of what the authors wrote reads like product information from the pharmaceutical industry. In view of the authors’ lists of competing interests, this makes a lot of sense.
Of course, studies of the adverse effects of therapy using checkpoint inhibitors will need to be undertaken. But an important aspect of such studies will have to be patients’ quality of life.
Why has it not been investigated what happens when the financial resources that these medications consume are invested in comprehensive palliative care for patients with advanced tumor disease? Resources and money are often lacking in this setting.
I am convinced that palliative care that is as generously funded as these uncertain medications would have the same effects in patients’ survival, but without the severe adverse effects.
We oncologists should not be blinded by the pseudo-religious cure promises of the pharmaceutical industry, but we should once again put the whole human being at the center of our activities. Treating severe adverse effects of medications is important, but it isn’t a task that gives our jobs meaning.
Dr. med. Martin Rotsch
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Heinzerling L, De Toni E, Schett G, Hundorfean G, Zimmer L: Checkpoint inhibitors—the diagnosis and treatment of side effects. Dtsch Arztebl Int 2019; 116: 119–26 VOLLTEXT|