As an oncology nurse, if I listened to the family members of an affluent, elderly patient debating at his bedside his right to receive cancer treatment, insisting he is too old, I would suspect elder abuse, and call for a social service consultation. Yet, this very scenario is occurring throughout the media in response to Warren E. Buffet’s announcement last week that he has stage I prostate cancer and will undergo eight weeks of daily radiation treatment, beginning in July.
The hullabaloo is in regards to guidelines established by the U.S. Preventive Services Task Force (USPSTF) recommending that men over age 75 not receive prostate cancer screening, aka the simple PSA blood test. 81 year-old Buffet not only received the PSA test, but when the results came back raised, he under went a prostate biopsy, which is also a no-no for a man his age per USPSTF guidelines. This is how his prostate cancer was diagnosed. USPSTF recommendations for treating slow-growing stage I prostate cancer consist of a digital rectal exam (DRE), and PSA test every 3-6 months, with annual prostate biopsy (see link above). Mr. Buffet’s choices for cancer treatment drives at least one oncology urologist batshit. By the way, the USPSTF is the same task force that presented new mammogram guidelines in 2009, sending women’s health groups to arms.
I’m no expert on prostate cancer, hell; I don’t even have a prostate. But if I did, I would consider it my right to choose how to treat it if it were diseased, assuming I am presented with appropriate choices. There are a few things I do know: Warren Buffet is one of the good guys. An outspoken advocate of fair play, he proposed The Buffet Rule a $47 billion tax increase on the nation’s richest households, which the House voted down earlier this month. He is also one of 81 billionaires pledging to give away more than half their personal wealth to philanthropy when they die.
Do I believe Warren Buffet deserves special health care privileges because he is powerful, wealthy, and generous? No. I believe everyone has the right to their informed health care choices, and have those choices respected by their providers, families, and friends, without scrutiny. A cancer diagnosis and treatment is difficult enough without this added burden, whether the patient is unemployed, homeless, or the third richest man in the world.
A man with the power and affluence of Mr. Buffet is most likely unconcerned about the opinions of the media, and even less with mine. But for what it’s worth, Mr. Buffet, from an oncology nurse in Portland, Oregon, I wish you the best throughout your cancer treatment, and send positive thoughts for a speedy recovery.
I think the biggest thing to heed to is that it’s a “recommendation”. There is a huge difference between an unhealthy 65 year-old and a healthy 85 year-old. I think if you body is in good enough shape to handle treatment you should have the right to decide despite reccomendations. Age reccomendations shouldn’t be so binding!
They are teaching in my nursing school that prostate cancer usually develops slower than other forms, and my professor (geriatric np) from memory also strongly did not recommend treatment to someone in old age. As an oncology nurse do you believe we should be having alternative discussions in school regarding how we educate pts on this topic so they can make informed decisions? Im also wondering if the age recommendations influence insurance coverage of these treatments..
Generally speaking, I agree with your professor, and the USPSTF guidelines. Over-treatment is certainly to be avoided. The key word here is “guidelines.” At the bedside, nurses are confronted with individual patients, not generalities. As TriCourt asserts, “there is a huge difference between an unhealthy 65 year-old, and a healthy 85 year-old.” Each patient needs to be assessed individually, and presented with all appropriate options for treatment. We have not received information regarding the pathology of Mr. Buffet’s cancer, by the way.
The guidelines recommend an 81 year-old with stage I prostate cancer have a DRE (digital rectal exam) and PSA every 3-6 months, with annual prostate biopsy. While 8 weeks of daily radiation is aggressive, one source has estimated Mr. Buffet’s life expectancy at 12 years. That’s a lot of DRE, PSAs, and 12 biopsies, which may find the cancer progressed anyway, and radiation necessary. No one knows, and this is why its Mr. Buffet’s choice. Personally, when faced with cancer, I chose aggressive treatment too, without regret. My attitude towards cancer is, if I’m going to play, I’m going to play to win. Along this thought process, I commonly hear patients with cancer, particularly tumors, express wanting to get the damn thing out of their bodies asap. Faced with grim prognosis, other patients refuse treatment altogether. A nurse needs to be prepared for all of these patient reactions.
In regard to insurance coverage: I suspect guidelines such as these will eventually predict insurance coverage. It’s probably why the USPSTF exists. Retrospective review of past results is used to establish level of treatment necessary to benefit the most patients safely. This information will most likely become the insurance industries’ norm. Utilizing shrinking health care resources to avoid waste, and over-treatment of patients is laudable, so long as a “who to throw off the lifeboat” mentality is also avoided.
One last point: Mr. Buffet may have a CEO contract with board members specifying responsibilities regarding his health in order to maintain leadership. Don’t know; just throwing it out there.
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