do most cancer center just want to make money

icey · February 2010

Hi Ladies, I went to the oncologist today. He tried to get me to take chemo Ac he said. I had already decided agains chemo because it would only benefit 3 or 4%. He also tries to talk me into clinical trials everytime I go. He wanted me to go into a trial for the intermediate oncotype dx scores. If u go into the trial the trial decides if u get chemo or not. I told him no for the third time I don't think there is enough benefit for a grade 1 cancer. I ask him about the new study about asprin that has recently came out and he tried to tell me that the study was done on nurses who did not have cancer. I told him to reread the article becasue all the nurses in the study had bc. What I don't get is all he wanted to talk about was chemo that might benefit me 3% and not about the asprin study that suggest that it can keep a reoccurance from happening by 50% and it is said to help dying from the bc at 71 percent. Is it because of the chemo is a good money maker? My cousin is a doctor and he gets bonus pay for every test he orders at the clinic he works at. Is it the same way for oncologist? Do they get more money for suggesting chemo or clinical trials. Any thoughts Ladies

idaho · February 2010

Of course he makes money on chemo. The more appointments you have the more money he makes. The more drugs he gives you the more money he makes. This is just my opinion... but have you ever seen a poor doctor? They all have fantastic houses... drive expensive cars.. makin that money somewhere! Cancer is a big money maker. Tami

petjunkie · February 2010

I disagree. The doctor makes money for your visits with him, but not for your chemo treatments. Clinical trials help advance the treatment options for all of us, and the women who will get BC in the future. I would not trust a doctor who didn't tell me about every trial available to me.

I think everyone has to decide for themselves about chemo, and what best fits their case. All of us are different with different degrees of cancer, etc.

I had stage 0 DCIS with just a microinvasion of IDC. Chemo was not recommended for me after mastectomy. Two years later, I have mets in more than 30 spots in my bones and 13 mets in my liver. I'm 35 years old, Stage IV, and doing chemo now to buy myself some more time.

I read the aspirin study and don't find it all that encouraging, but others are very excited by it. Maybe there will be a larger clinical trial for this that you could participate in? But for me, just my opinion, if my doctor were telling me that I didn't need chemo (a proven therapy) and instead should try aspirin based on this one article, I'd be calling her crazy.

My doc works her ass off and I believe she truly cares about all of her patients and what happens to us. If you don't feel that way about yours and you don't trust his judgement, you should look for someone else. You deserve to have a doc that you feel is in your corner and always (and only) looking out for YOUR best interests. Good luck!

icey · February 2010

Dear Pet Junkie, I am sorry to hear about your stage 4 dx. I was wondering if u took tamoxifen or herceptim after you massectomy. Don't get me wrong I think chemo is a great drug that saves lives it just doesn't work well on grade 1 cancers. The oncologist did tell me that tamoxifen would benefit me 12 percent a lot more than chemo. As far as the asprin study goes it is the second one and it was a 10 year study. I am glad to see you are on Zometa a new study is out about zometa helping keep cancer at bay and not just good for bones. I did agree to do the clinical trial to take the zometa along with tamoxifen. Icey

otter · February 2010

Well, petjunkie already said almost everything I wanted to say, and said it much better (and more convincingly) than I could have said it.

icey, there are lots of women on these boards who had stats similar to yours and did decide to have chemo. You are young (48), and you had a tumor that was larger than the magic threshold of 2 cm. Yes, it was Grade 1, but you said elsewhere that your Oncotype DX score was 22 (which corresponds to a 14% risk of distant recurrence). So, even though you thought the benefit of chemo was too low, other women would gladly have accepted that "3 or 4%" (my onco would have said it was 4 or 5%) absolute benefit and put it in the bank.

It was your choice, though; and there are other women who would agree with what you decided to do. Your onco's job was to lay out the options, along with the advantages and disadvantages of each. Since you were in a gray zone ("intermediate" risk of distant recurrence), nobody really knows how much benefit you would have gained from chemo. That's why the TAILORx Clinical Trial is being done. That's the study your onco told you about and encouraged you to join. The thousands of women who did agree to participate in that study will be providing results that will help many tens of thousands of women in the future. Finding enough people to participate in clinical trials is becoming a huge problem, so docs are really doing their civic (professional) duty when they tell us about the trials and encourage us to enroll.

Please, even though you felt like you were getting the "hard sell" ... it sounds like your onco was doing what he was supposed to do. He was making sure you knew the choices, and making sure you were certain of your answer. What if the situation had been reversed, and you had a large, aggressively growing tumor with a positive node, but your onco was wishy-washy about your treatment options and didn't really seem interested in whether or not you had chemo?

otter

icey · February 2010

Dear Otter. If my cance had been a grade 3 or er and pr neg or her2 pos or even in one lymph node I would have done the chemo. Today my onco decide my stage was 1 because the other 2 mm of cancer they found in the re excission was separate a a few mm from the orginal tumor so the stage 1 has a lower benefit from chemo. I like hearing about the trial but they really seem to be pushing the tailor x trial by asking 3 difernet times. If I hadn't seen 2 family members die from chemo I might receptive to the idea. If I were like a lot of these women who don't mind the chemo I would participate in the trial.

makingway · February 2010

Yes, yes and yes, it's all about the money. And petjunkies statement that the doctor only makes money from your visits and not your treatments is ridiculous! I had a oncology nurse tell me the same thing-she said they don't get paid for using the drugs and giving you the infusions. So, I asked her what they get paid for then. She said it was for 'chair time'...that's one hell of an expensive chair!!! If, what she said is correct then my regular 15 minute visit should have cost me $1000.00. It doesn't. The 'cancer industry' is a money hungry one with lots of people benefiting from our misfortune. The cost of prescriptions you need when doing chemo are outrageous. Emend, which is $420.00 for 3 pills. I would need that 6 times for a total of $2520.00. Zofrans' generic drug is $89.00 for 5 pills. I'm not sure how many of those one would need for each treatment. The other drug given is compazine, which is the only one that is affordable. And the Neulesta shot that is given for each chemo-(6) costs $3000.00 each, for a total of $18,000.00!

I brought the vitamin D study up with my oncologist and he discredited it. Who cares about preventing a recurrence? Only the cancer victim. The doctor doesn't otherwise he/she might be out of business.

petjunkie · February 2010

Wow. Disagree if you'd like, but I am not ridiculous. My oncologist gets paid for her visits with me, not from my chemo infusions or my prescription drugs. Drug companies and my nurses get paid for infusions. Maybe it's different for other people? But really, I don't think I wrote anything to warrant your comment. We can all have different opinions here and can be respectful of one another, can't we?

Icey, yes, I was on Tamoxifen for the two years between my mastectomy and my recurrence. Seems it didn't work for me. I'm just one of the people in that small percentage-- it just took one cancer cell to escape into my system. My lymph nodes are still clear-- the cancer seems to have spread through the blood vessels of the chest wall rather than the lymphatic system, which is unusual. I guess I'm just a special case all around Wink

My team and I made the best decision based on the information we had from the pathology of my original tumor. I wouldn't have chosen chemo back then and it wasn't even offered to me. I had a microinvasion of IDC, about 9mm, in the middle of a 9cm DCIS. A mastectomy and 5 years of tamoxifen was the best treatment available.

I just think it's important that you have a doctor who you trust and you feel really listens to you and explains everything to your satisfaction. If this aspirin study is important to you, it should be important to your doctor and he should do the research and then sit down and talk to you about it-- or refer you to someone who can. I'd like to believe that aspirin could be such a cure, but I just don't. For me, I'll take the chemo and the toughest drugs they'll give me. But at stage IV I'm in a different situation and am trying to stay alive, not just prevent recurrence. Remember that even women who do get a recurrence don't always have mets-- many local recurrences can be successfully treated. So recurrence doesn't always mean death, and treatments are getting better every year!

ananda8 · February 2010

Well some doctors get kickbacks for using certain chemo drugs.

State attorneys general have joined a whistleblower suit alleging that Amgen Inc. offered an illegal kickback to doctors by overfilling vials with the drug Aranesp and offering counseling on charging for this surplus.

The suit filed in the U.S. District Court for the District of Massachusetts Oct. 30 is focused on nephrology, but court documents state that the same practice was used in marketing Aranesp (darbepoetin) in oncology.

http://www.bcm.edu/cancercenter/?PMID=12894

And then there is this:

Unlike other doctors, medical oncologists (doctors who prescribe chemotherapy) can profit directly from prescribing certain drugs when they administer them in their offices. Oncologists can purchase chemotherapy at lower prices than the amounts that Medicare and other private insurance companies pays them. Then they pocket the difference. This mark-up, which historically can be as high as 86%, is called the chemotherapy concession.

http://www.cancermonthly.com/blog/2007/12/chemotherapy-kickbacks.html

And then there is this:

As Alex Berenson and Andrew Pollack laid bare in The Times on May 9, wide use of the medicines -Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson - has been propelled by the two companies paying out hundreds of millions of dollars in so-called rebates. Doctors typically buy the drugs from the companies, get reimbursed for much of the cost by Medicare and private insurers, and on top of that get these rebates based on the amount they have purchased.

Although many doctors complain that they barely break even or even lose money on the costly drugs,for high-volume providers the profits can be substantial. One group of six cancer doctors in the Pacific Northwest earned a profit of about $1.8 million last year thanks to rebates from Amgen, while a large chain of dialysis centers gets an estimated 25 percent of its revenue, and a higher percentage of its profits, from the anemia drugs. It seems likely that these financial incentives have led to wider use and the prescribing of higher doses than medically desirable.

http://www.consumersunion.org/pdf/Drug_Kickbacks_NYT.pdf

Cancer is BIG BUSINESS.

icey · February 2010

Dear Pet junkie, Thank you for sharing your story with me. I realize u feel like chemo might have helped your situation. But you never know. If u read the reoccurance thread most had chemo in the beginning. The administrator of the cancer center I go to( because she is a personal friend) tells me that chemo has not been proven to help in my situation. She told me the oncologist would try to talk me into chemo and not to do it. Also because I have relatives in the medical field, I understand how things work. One story I would like to share is that my best friends aunt got liver cancer about 15 years ago. She went to a big cancer institute and they told her nothing could be done to save her life. They offered her chemo to maybe give her a couple of months. She heard of a doctor that could cure cancer but she had to pay for the treatment herself and she had to go to mexico to get the cure. The doctor was american but he could only give her the treatment in mexico. The treatment worked. She is a firm beliver that cancer can be cured if it wasn't for the money being made from it.

otter · February 2010

Icey, I'm sorry my answer wasn't helpful. I posted a reply because you asked the question, "do most cancer center just want to make money". IMHO, the answer to that question is, "No."

However, it sounds as if you've already decided what the answer is. In your judgment, cancer centers are corrupt; oncologists are greedy; and we might need to go to Mexico to find the true cure for cancer, because cancer centers in the U.S. will not tell us about it.

That's fine, if that type of thinking makes you comfortable. We have to live with our decisions, so make the decisions that you think are best for you. After all, the hospital administrator who advised you to disregard your oncologist's advice might be right. For your sake, I hope she is.

BTW, those of us who had chemo did not agree to it because we "didn't mind chemo." I feel pretty safe in saying we all hated chemo. But, as petjunkie and I both said, women agree to have chemo because they hope it will offer them a bit of a safety net, even if it's a flimsy one. Of course it's true that many of the women who ended up with metastatic BC did have chemo at some earlier stage. No one is suggesting that chemo is 100% protective.

And, after all, your original post wasn't a question about whether or not you should have chemo -- you had already made that decision. So my discussion about the size and aggressiveness (i.e., Oncotype DX score) of your cancer was not relevant to your question.

otter

icey · February 2010

Dear Otter, Your opinion is important to me. I know that no one wants chemo. I also know that women with breast cancer try to do all they can to keep cancer away. I have just seen many people die from the side effect. My dad got leukemia from chemo. My auut died from stroke that the strong chemo she was taken. Other people I know the chemo didn't seen to help. I am tring to do everything I can to stay alive. I am just afraid that the chemo might kill me faster than the bc. And no otter I don't think all cancer centers are bad and oncologist are greedly. But I am being treated in a state than I am not from and don't know what advice to follow. I am just very scared of making the wrong treatment choice.

otter · February 2010

icey, have you tried to get a 2nd opinion from an oncologist at a different hospital or treatment center? I'm sorry if my words were harsh. I didn't mean to minimize your concerns. We are all scared and hurting from this experience; and we are all hoping so much that our decisions (and those of our doctors) will turn out to have been the right ones. But, we all live with the fear that what we did was too late or not enough; or that what we did will cause worse problems than cancer would have caused. Some women are able to suppress those fears and go on with their "normal" lives. For others, that's not so easy.

As petjunkie said, what you really need to do is find an oncologist or treatment team that you can trust. I am worried that, with your past experiences and those of your family members, you will have a hard time trusting anyone in the mainstream medical profession. I do encourage you to try to find another oncologist you can talk with, though. You don't have to go there for treatment -- you just need to find someone who will explain things without making you feel pressured and give you the reassurance you seek.

Hugs, icey...

otter

Ezscriiibe · February 2010

Frankly, I agree that icy has already made up her mind, is convinced, along with many others, that doctors are corrupt and it's in THEIR best interests to keep cancer viable.

There is no rational discussion that can be held with people of that mindset. If that is the experience they are having with their health care professionals, and they have yet to find caring, patient, hardworking and diligent health care providers, then I feel for them.

Shit happens in all kinds of treatments. My step-father's brother had a stroke and died because of the contrast dye they gave him when they were checking out his arteries years ago. It's a rare side effect and it does happen, but that doesn't mean that doctors willy nilly order those tests with little or no regard to the patient, but only to their own bottom line.

Chemo helps more people than it hurts. If one wants to believe that their grade or stage doesn't make them a good candidate, then that's one thing. That's a personal decision. But to try to rationalize and mitigate your own decision by casting doubt and distrust on the very people who are trying to keep one alive, well, that's simply disingenuous and copping out as far as I'm concerned.

Plus having a "personal friend" tell one comments like that is quite simply atrocious. I think that Personal Friend needs to get into a different line of work.

Wonder how many people she's willing to share who now have a full life back due to the care and standard of care they received through the cancer center and oncologists? Good grief. What a jaded people we have become!

By the way, my personal care physician put his arms around me and cried with me when I went to see him just before my chemo treatment. He has been with me for a number of years, and took care of me for almost 6 months almost free of charge when my insurance company dropped him as an in-service physician. My gastrointestinal physician I had last year when we thought I had diabetic stomach (your stomach freezes and won't empty the contents, which just accummulate and grow and expand until you explode, I guess), sat with me for over 6 hours the first night I was in the hospital because I was in so much pain and he was convinced I did not have diabetic stomach (another doctor diagnosed me). He ended up being right and he even came to work with me at a hospital where he has no official duties. He didn't charge me for any of that. (or my insurance compan).

I trust all of my providers, and when I don't, I fire them and hook up with someone whom I feel I do have a relationship.

Will they make money? Sure they will. But I will get care that I know I deserve.

icey · February 2010

Dear Ezscriibe, I was talking about a stage 1 node negative cancer. Not all bc. I just think some not all oncologist like to do over kill. If my cancer had been big or more agressive then I would have taking chemo. I'm just concerned about making the wrong choice in my peticular situation. I am also the type of person who researches everything. I did a lot of research in college about a lot of different medical problems. The research that I have done since being dx with bc tells me that oncologist really don't if chemo benefit those with intermediate risk( onco score 22) or not. That is why they are doing the trailor x trials. I am scared to take a chance of getting worse probems by taking chemo if there is no really proof that it will help. The tamoxifen on the other had has side effect but I am willing to take it for 5 years because there is really proof that it decreeses the chance of reoccurance by 12%. I did ask the oncologist if I were to choose either tamoxifen or chemo which one would benefit me more? He said tamoxifen. I know that we are all different and have different types of cancer so I was only speaking about my situation not all bc.

ananda8 · February 2010

It is equally foolish to think that all doctors are corrupt or that the money involved in treatment doesn't corrupt some doctors.

I am fortunate that I go to a VA hospital where the doctors are excellent and are not paid by the procedure or receive part of their income from prescribing drugs.

Now I know for a fact that the VA hospital is one of the best in the nation and is affiliated with one of the top 20 colleges for cancer research in the country. There are unfortunately, terrible VA hospitals. I am trying to make the point that we have to go into things with our eyes open and if necessary be our own advocates.

I am estrogen/progesterone positive and Her2 borderline. The protocol says if one scores <2 for Her2 chemo is not useful. If it is 2 or greater chemo is recommended. My results came back 2 on the nose. Since the expression was so low, I decided to risk death by cancer than death by congestive heart failure. (Herceptin has a side effect of irreverible congestive heart failure in 10% of the patients who take it.) The nice thing about my oncologist being on a salary was I knew his advice was about the options not his wallet.

It is sad that distrust has to be part of the equation, but blind trust is just plain foolish.

cherneski · February 2010

Well just my 2 cents here. Yes, of course they want to make money. I believe most Dr.s especially in oncology really do it for the love of helping people. But Dr.s are ppl, there are some great ones, some ok ones, some shady ones and some just mean ones.

I wouldn't stay with a Dr. that I thought didn't have my best interest in mind. Period. If I felt a Dr. was trying to push tx, medication, whatever on me that was NOT in my best interest I would be out the door!

I also believe there is a CURE for cancer and it is buried deep deep away somewhere to never be found. Because treatment for cancer is a $240 Trillion a year business. Do you really think they could afford to give us the cure.

icey · February 2010

Thank notself and cherneski, I am happy to see thank some people don't think I am crazy to question and research for my self about bc treatment. I don't think my oncologist is a bad person but he is very young and work for the cancer center. There is no reason for him to feel bad to suggest chemo, but I have read a lot on these sites about people in my exact situation not taking chemo and their oncologist was ok with it. My radation oncologist was ok with no chemo. He thinks radiation and tamoxfen would be enougjt. I also know that my radiation will cost 66 thousand dollars 2000 a treatment for 33 treatments. Before I got bc I had no idea it could cost this much. Thankfully I have 100% insurance coverage. I have no idea how much chemo would be. I not very good at expressing my fears but Notself sum up what I think very well.

GryffinSong · February 2010

My diagnosis is somewhat similar to yours. I was advised that I would not need chemo if I had no node involvement. It was my node malignancies that pushed me over the edge. Ditto with radiation. If I'd chosen lumpectomy, I'd have had rads regardless of node involvement, but with a mastectomy, if my nodes had been clear I wouldn't have needed rads either.

Did you have a mastectomy or lumpectomy? That might also make some difference.

Ultimately, you need an oncologist that you trust. If he's not listening to your wishes, and continually pushes you to do something else, then perhaps he's not the right doctor for you. I would suggest a second opinion, and see where that gets you. For what its worth, I talked with my doctors about my financial situation. They were very helpful about getting me medication samples (free) and in minimizing (and sometimes waiving) their fees. I truly believe that my doctors want to help people.

London-Virginia · February 2010

Dear Petjunkie,

Just a line to say I am sorry things are so difficult for you. Your experience and views are perfectly valid.

But, myself and a lot of others don't post on here any more due to the abrasive and unpleasant posts that appear on this site, and I must say some of the posts in this thread were not very sensitive to your situation. I am siorry for that and just thought I would send a line to wishe you all the very best -

icey · February 2010

Dear Grayffinson,. I have a lumpectomy and then a re exision for clean margin which they got. They are having trouble deciding if I am a stage 1 or 2 because the 2 mm of cancer was not connected to the 2 cm cancer so as I was leaving the onco office he was argueing with pathology that I was stage 1 if the invasive cancer had a break in the tissue instead of a continuation. So it is all confusing to me. I will probably seek another opinion. If I were u I would have taken the chemo for node involvement. Did u have radiation on the lympnodes too. Was radiation bad?

Ezscriiibe · February 2010

icy, no one is questioning your personal research or your personal decision. I didn't see one person challenge you on that. If you are sensing it, it is possibly a projection of your own self-doubt, I don't know.

We've all admitted that it is your own choice and we all have our own background, baggage or whatever that we bring to the table.

The question you posed was not about your decision, however. You are asking us to make a judgment call about not only your own oncologist, whom we DON'T know, but whom we only know through your own filter, as well as question all cancer centers in general.

And every single person responded appropriately to your issue with your own oncologist. And that response was, to a woman, you need to find one you can trust.

Plus, no disrespect to cherniski, but in no way do I believe that anyone is holding back any cancer cure. I know there are people who rabidly believe that, and, quite frankly, that saddens me for them.

I don't care how big a "bidness" it is, the people who would have access to the "cure," also have family members and loved ones who would be and most likely have been affected by cancer. It's completely incongruous that people working in the field that deals with life and death would "hold out" for money.

There are plenty of illnesses and disease that are trillion dollar businesses, too. I just don't believe that a cancer "cure" would be kept from us because of that. It would be damn near impossible to do, logistically, anyway.

We have come a long way in the way we can diagnose and treat cancer. Fewer and fewer people die from what used to be guaranteed death-sentence cancers, breast cancer being one of those.

You are correct that doctors are people, too. But to insinuate that the whole thing is a racket is counter-productive to ones own health. How could or would we ever be able to trust our treatment options for anything, much less cancer? What I have noticed a shift in over the years, and it's a good shift, is that more and more patients are taking control of their health care, and more and more are active participants in the entire process. This is a good thing, and we are now able to say, "This one isn't working out? You're fired." That was unheard of years ago. Doctors were gods, and you were never EVER to have access to your own records.

Transparency in everything is what keeps the honest ones honest and hones out the dishonest ones. We have to be vocal and active advocates for our own health. Icy, that is what you have done. But don't paint broad strokes with your own experience. It's just not fair to you or others. Learn what you need to from this experience and work just as diligently with your next oncologist, if you decide you need to move on.

Bren-2007 · February 2010

Hello Icey,

I meant to post to you yesterday .. and got sidetracked by a stomach virus. yuck!

I was 3 years older than you (51) at diagnosis. Stage I, no nodes, and ER+. No chemo was recommended for me. A friend of mine was 49 and diagnosed at the exact same time I was. She was also Stage I, but chemo was recommended for her because she was under age 50. She turned it down and went with a lumpectomy and radiation (my treatment choice as well).

The physicians where I was treated are definately not in it to make money. I was treated at a very small regional hospital in a very depressed economic area of Virginia. However, for profit cancer centers are just that .. for profit. It's a business regardless of the high level of care.

I wish you all the best ... keep us informed of your progress!

Hugs,

Bren

pip57 · February 2010

You know, there is a lot of information other than size, grade, stage, hormone and nodal status in your pathology report that is statistically significant. Perhaps that is why there are different tx for bc that 'seems' to be the same. I would google AND ask my onc about all the wording in the report before deciding against his recommendations. But be prepared to read things that you don't like.

icey · February 2010

Dear Prettyinpink, I had the entire path report explained to me. That is one of the reasons I choose no chemo because there was no lymphvascular invasion. Therefore there wasn't much chance of spread through my lymph system or through blood vessels. The cancer was also inside a sclorsising lesion. The oncologist said that over 2cm was common protocol for chemo. My oncologist is not certain it is a stage 1 or 2 because 2mm was in a little bit different place. He thinks if is stage 1. He just wanted my to do chemo or the trailor x trial.

do most cancer center just want to make money

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