Overtreatment of cancer
Overtreatment of cancer refers to the aggressive management of cancers that are unlikely to progress or cause harm, often resulting in unnecessary procedures and side effects. This phenomenon is increasingly scrutinized, particularly in cases like prostate and breast cancer, where some patients may have undetected cancers that do not pose immediate threats to their health. Evidence suggests that for certain slow-growing or non-progressive cancers, a strategy of watchful waiting may be more beneficial than aggressive treatment. Many patients remain unaware of the risks of overtreatment, with limited discussions about this concern arising in healthcare settings.
The potential side effects of cancer treatments, which can significantly affect quality of life, underscore the need for careful consideration of treatment options. Conditions such as pain, fatigue, and depression can outweigh the benefits of aggressive interventions, especially in older populations, where the risks may be greater due to age-related health considerations. Advances in diagnostic technologies, while improving detection rates, also complicate the balance between identifying cancer early and avoiding overtreatment. Engaging in open discussions with healthcare providers about treatment strategies can help ensure that patients make informed decisions aligned with their health goals and quality of life considerations.
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Overtreatment of cancer
DEFINITION: Overtreatment of cancer patients generally refers to the aggressive treatment of cancer in a patient whose cancer is considered extremely unlikely to spread. It can also refer to the use of an unnecessarily aggressive treatment strategy.
Causes: The standard procedure is to treat anyone who has cancer in the way that is believed best to destroy the cancer. Some people, however, believe that not every person who has cancer is best served by an aggressive cancer treatment plan and that, in some cases, it may be in the patient’s best interest not to treat the cancer at all.
A growing body of evidence suggests that it is not in the best interest of every patient to aggressively treat every cancer. However, patient awareness of the overtreatment of cancer remained low, and only a small percentage of patients reported discussing the issue with their healthcare team. Treatment of prostate cancer and breast cancer especially have come under scrutiny. Researchers have found that there are a significant number of cases in which an autopsy has revealed a case of prostate cancer, but the man had no symptoms of the cancer while alive. This type of evidence is often the basis for arguments against aggressively treating every case of cancer. Melanoma and thyroid cancers are two additional cancers often affected by overtreatment.
Some types of cancer are very slow to grow or may never grow at all and are considered extremely unlikely to spread. Therefore, an approach of watchful waiting may be more appropriate for some individuals than an aggressive treatment plan involving surgery, chemotherapy, radiation therapy, or a combination of treatments. Further, advances in imaging and diagnostic technology may complicate the overtreatment of cancer as they make detection more accurate and effective but contribute to the delicate balance between early detection and overtreatment.
Side effects: Cancer treatments have many side effects that can significantly decrease a patient's quality of life. These can include pain, fatigue, nausea, hair loss, appetite loss, and depression. Cancer patients should discuss with their healthcare team all the benefits of prompt, aggressive treatment, the likely side effects, and the possible risks of a watchful waiting approach.
Older populations: Older populations may be the group most likely to be affected by the overtreatment of cancer. If a person is of a very advanced age when a slow-growing cancer is diagnosed, it may be unrealistic to assume that the person is going to have enough benefit from treating the cancer to outweigh the negative impact on daily life from the cancer treatment being considered. Instead, it may be more beneficial for the patient to make regular appointments with a doctor to check and ensure the cancer has not grown or spread.
Bibliography
Esserman, Laura J., et al. “Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement.” JAMA, vol. 310.8, 2013, pp. 797-8, doi:10.1001/jama.2013.108415.
Falchook, Aaron. “Overdiagnosis and Overtreatment in Cancer: Point/Counterpoint.” Cancer Network, 3 June 2014, www.cancernetwork.com/view/overdiagnosis-and-overtreatment-cancer-pointcounterpoint. Accessed 28 June 2024.
Grady, Denise. “Look for Cancer, and Find It.” The New York Times, 7 Apr. 2014, archive.nytimes.com/well.blogs.nytimes.com/2014/04/07/look-for-cancer-and-find-it. Accessed 28 June 2024.
Housten, Ashley J., et al. "A Review of the Presentation of Overdiagnosis in Cancer Screening Patient Decision Aids." MDM Policy & Practice, vol. 4, no. 2, 2019, doi.org/10.1177/2381468319881447. Accessed 28 June 2024.
LeWine, Howard E. “Doctors Often Don’t Reveal Cancer Test Overtreatment and Harms.” Harvard Health, 22 Oct. 2013, www.health.harvard.edu/blog/doctors-often-dont-reveal-cancer-test-overtreatment-and-harms-201310226790. Accessed 28 June 2024.
Plain, Charlie. “Low Awareness of Breast Cancer Overdiagnosis and Overtreatment Among U.S. Women.” University of Minnesota School of Public Health, 27 Sept. 2017, www.sph.umn.edu/news/low-awareness-breast-cancer-overdiagnosis-overtreatment-among-u-s-women/. Accessed 28 June 2024.