Prolonging life carries more weight

Doctors are more apt to recommend a more costly therapy to patients if it were determined to prolong the patient's life rather than just improve quality, according to a recent study from Medical Decision Making (published by SAGE).

Using a survey of the decision-making process, authors were able obtain data to determine the relative importance oncologists place on quantity of life compared to quality of life in chemotherapy decisions. From this, they found a significant majority of respondents (71.8%) illustrated a greater value they placed on life-prolonging treatments rather than on quality-enhancing ones.

"The costs of cancer drugs have increased markedly over the past few years," wrote the authors. "However, interpreting the cost effectiveness literature and translating it into clinical discussions can be difficult."

The study also points out that there are no adopted methods for physicians to analyze cost-effectiveness in this or any other scenario. This is increasingly important in the United States where there are no governing bodies to set limits to costs of treatments. Countries such as United Kingdom, Canada, Australia and New Zealand do have set thresholds as part of their national healthcare systems.

According to the study, doctors placed a wide range on the cost of reasonable treatments that varied from $10,000 to $5 million. Additionally, there was similar variance in the range from doctors who were confident in using cost-effectiveness information and those who did not.

"A number of factors are probably at play in driving this finding. However, I would argue that length of life is a more tangible measure for most practitioners compared to quality of life. Medical trials highlight survival data, clinicians discuss prognosis as a timeline rather than a list of symptoms, and trainees learn about 'time of death,' not 'state at death,' in our medical schools," said study author Dr. Michael Kozminski. "Moreover, when a physician develops a relationship with a particular patient, she may take every measure to extend that patient's life, regardless of side effect profile, because of their shared bond – a documented phenomenon known as the 'Rule of Rescue.'"