Cancer treatment story prompts response

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An oncologist and former chief medical officer at St. Joseph Regional Medical Center is worried that a recent story in the Lewiston Tribune may lead readers to believe that doctors are overtreating their cancer.

The story from Kaiser Health News that ran on the Tribune's Oct. 29 front page featured a breast cancer patient who was upset that her doctor prescribed a six-week course of radiation without informing her of a three-week option.

Kaiser Health News describes itself as a nonprofit news service that is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with health care conglomerate Kaiser Permanente.

Dr. Michael Rooney said he thinks the story gave people the impression that the patient got twice as much radiation as she needed.

"The fact is that she received the same dose of radiation over six weeks that she would have received over three weeks," Rooney said. "The total dose of radiation to treat a specific cancer is fixed at the time that the treatment is prescribed."

That total dose is then broken into pieces called "fractions" that are delivered once or twice a day over a number of weeks, he said. Smaller doses may take more weeks to deliver, but are easier to withstand for most patients.

While Rooney's experience points to the longer course of treatment being less toxic, the Kaiser Health News story quoted a doctor from the University of Texas MD Anderson Cancer Center who cited studies showing the same or even milder side effects from the shorter regimen.

Rooney said he and other specialists he knows believe the opposite is true, like St. Joseph's radiation oncology specialist Dr. Edward Abraham.

"He thought the article did give patients the idea that we were doing too much," Rooney said, noting that Abraham got questions about overtreatment after the Kaiser Health News story ran. "He's actually experienced some blowback from that."

Rooney added that patients should never be afraid to ask such questions, however. And he didn't discount the potential value of a shorter course of radiation. It can be cheaper, as well as more convenient for those who don't live near their cancer center.

"Fewer trips to the doctor's office for somebody who lives in Grangeville is important," he said, noting that St. Joseph's radiation oncology center offers both courses of treatment and gives patients the information they need to make an educated choice.

But all things being equal, Rooney said the center typically suggests the course of treatment that will be easiest to tolerate.

And while overtreatment does exist and can cause adverse effects, he said it is rare. But the unfortunate side effect is that people may come to believe that health care is a purely profit-driven endeavor.

"I feel like it's painting doctors in general, and maybe the medical system as a whole, as trying to find the most expensive way or most labor-intensive way to manage a patient," Rooney said of the Kaiser Health News story. "That isn't the place that we start from."

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Mills may be contacted at jmills@lmtribune.com or (208) 848-2266.

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