4 ms·

It is argued in the article that the survival rate didn't go up, but rather how it was measured: earlier detection means a longer period of survival since detec

by smooc 7y ago

It is argued in the article that the survival rate didn't go up, but rather how it was measured: earlier detection means a longer period of survival since detection. You argue that there was rapid progress in the last decade. The article agues the opposite (over decades even). It does this with citations and meta analysis where they find that much of the 'rapid progress' is not replicable. The article doesn't say that immunotherapy is not meaningful, but it does say it is over sold where there is hardly evidence of their benefit. You also argue that the cost will come down, however there is no evidence for this. To the contrary even: according to the article it is going up significantly without any indication of improving. Why do you state that the "bizarre claim" of not having improved treatment is "just wrong" without providing any supporting evidence for this?

HeadsUpHigh 7y ago
All these arguments are just arm chair discussions by people who have literally zero knowledge or involvement in cancer treatments. The overall 5 year survival rate has increased significantly and for some types it has increased multiple-fold thanks to new drugs. And regardless, even in types with lower success rates the side effects are generally way more manageable than traditional chemotherapy.
- VHRanger 7y ago
  If we diagnose earlier, it's expected that the 5Y survival rate improves even if the patient dies at the same age as she would have in the counterfactual.
  - mrosett 7y ago
    Sure, that can show up in aggregated statistics. But it used to be that there was no treatment for all sorts of metastatic diseases. Now there are. That's not a function of earlier detection. This isn't made up; we have real RCTs demonstrating this stuff....
    - freethinker9 7y ago
      As long as we're talking about what 'used to be', there didn't used to be 4 year olds getting Leukemia. And there didn't used to be this idea that 40% of the entire population will be diagnosed with cancer at some point. (!) As far as I can tell, the article is full of facts, obvious stuff really, and the naysayers simply don't want to face the harsh reality that cancer 'research' is total bullshit and always has been. What's causing all of this cancer? Are we just not praying hard enough, is that it? Wait, I know--how about all of the CARCINOGENS that are everywhere, in everything, and are EPA and FDA approved also, with the revolving door always swinging as suits pass from government to big business and back again on their merry way? No...? OK then, maybe we just need to go buy more pink ribbons and 'race for the cure.' Get Usain Bolt in there. He'll turn things around. (Why hasn't anyone hired this guy yet?) And if that doesn't help, maybe try a little prayer also, perhaps.
- nonbel 7y ago
  The people who don't know what they are talking about (or are maliciously feigning ignorance) are those who look at 5 yr survival without considering the effect of increased surveillance/screening. https://en.m.wikipedia.org/wiki/Lead_time_bias https://en.m.wikipedia.org/wiki/Lead_time_bias
  - stewbrew 7y ago
    You have to distinguish between screening detected cancer and symptomatic cancer. 5yr srvl rates say little in the former case but they are relevant for the latter. You'd really prefer having skin cancer today than ten years ago. Your short exchange of arguments is a good example of what goes wrong in the public discussion.
    - nonbel 7y ago
      I don't understand what you mean by "detected cancer" and "symptomatic cancer". Eg if a cancer is already detected then by definition it is impossible to screen for it.
      - mbreese 7y ago
        (Screening detected) Found during a routine/annual colonoscopy/mammogram/etc... vs (Symptomatic detected) Hey, what is this lump here? Why am I so tired? etc...
        nonbel 7y ago
        I see, it should have been written "screening-detected" to be as clear as possible. Yes, the latter is more likely to be comparable over time but it will still have issues with changes in how likely someone is to report it to their doctor, etc.
  - mrosett 7y ago
    Look, just because a bias exists doesn't mean that it explains every single bit of improvement. We have randomized controlled trials showing that these drugs work.
mrosett 7y ago
Re: cost - you're conflating two different things. The cost of new drugs at the time of introduction has gone up. The new drugs of 2020 are more expensive than the new drugs of 2000. However, with a few high-profile exceptions, the cost of any individual drug goes down over time once generics are introduced. The expensive new drugs of today are the affordable generics of tomorrow. Biologics are genuinely expensive to manufacture, so the cost of the current generation of immunotherapies will remain substantial, but it will ultimately drop to a fraction of what it is today. Re: survival benefits - population level data about overall survival is tricky to get right, and issues like earlier detection leading to longer measured survival without actual benefit are real. And I'm sure that if you tweak the statistics just right, you can argue that all of the advances of the last 50 years have accomplished nothing. But that ignores a hugely important fact: we have randomized controlled trials showing that people who get these drugs live longer than an identical population that doesn't get them. I was going to spend a while finding citations, but let's go with the comment /u/dannykwells just posted: "This article is absolute 100% bullshit. -Metastatic melanoma: used to be lethal, now 50% cure rate.[1] -Non small cell lung cancer: same, now around 25% [2] -Breast cancer used to have a terrible prognisis, now 75% survive. [3] -Not to mention the myriad of blood cancers with new, strong, cell therapy treatment options with 40-50% durable cure rate. I don't know this person, but seriously, whoever he is, fuck you dude. Millions of us work day and night trying to improve care, and 99% of us arent getting rich. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 [2] https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 [3] https://www.breastcancer.org/research-news/20100930" https://www.breastcancer.org/research-news/20100930"

by smooc 7y ago

HeadsUpHigh 7y ago

All these arguments are just arm chair discussions by people who have literally zero knowledge or involvement in cancer treatments. The overall 5 year survival rate has increased significantly and for some types it has increased multiple-fold thanks to new drugs. And regardless, even in types with lower success rates the side effects are generally way more manageable than traditional chemotherapy.

VHRanger 7y ago
If we diagnose earlier, it's expected that the 5Y survival rate improves even if the patient dies at the same age as she would have in the counterfactual.
- mrosett 7y ago
  Sure, that can show up in aggregated statistics. But it used to be that there was no treatment for all sorts of metastatic diseases. Now there are. That's not a function of earlier detection. This isn't made up; we have real RCTs demonstrating this stuff....
  - freethinker9 7y ago
    As long as we're talking about what 'used to be', there didn't used to be 4 year olds getting Leukemia. And there didn't used to be this idea that 40% of the entire population will be diagnosed with cancer at some point. (!) As far as I can tell, the article is full of facts, obvious stuff really, and the naysayers simply don't want to face the harsh reality that cancer 'research' is total bullshit and always has been. What's causing all of this cancer? Are we just not praying hard enough, is that it? Wait, I know--how about all of the CARCINOGENS that are everywhere, in everything, and are EPA and FDA approved also, with the revolving door always swinging as suits pass from government to big business and back again on their merry way? No...? OK then, maybe we just need to go buy more pink ribbons and 'race for the cure.' Get Usain Bolt in there. He'll turn things around. (Why hasn't anyone hired this guy yet?) And if that doesn't help, maybe try a little prayer also, perhaps.
nonbel 7y ago
The people who don't know what they are talking about (or are maliciously feigning ignorance) are those who look at 5 yr survival without considering the effect of increased surveillance/screening. https://en.m.wikipedia.org/wiki/Lead_time_bias https://en.m.wikipedia.org/wiki/Lead_time_bias
- stewbrew 7y ago
  You have to distinguish between screening detected cancer and symptomatic cancer. 5yr srvl rates say little in the former case but they are relevant for the latter. You'd really prefer having skin cancer today than ten years ago. Your short exchange of arguments is a good example of what goes wrong in the public discussion.
  - nonbel 7y ago
    I don't understand what you mean by "detected cancer" and "symptomatic cancer". Eg if a cancer is already detected then by definition it is impossible to screen for it.
    - mbreese 7y ago
      (Screening detected) Found during a routine/annual colonoscopy/mammogram/etc... vs (Symptomatic detected) Hey, what is this lump here? Why am I so tired? etc...
      - nonbel 7y ago
        I see, it should have been written "screening-detected" to be as clear as possible. Yes, the latter is more likely to be comparable over time but it will still have issues with changes in how likely someone is to report it to their doctor, etc.
- mrosett 7y ago
  Look, just because a bias exists doesn't mean that it explains every single bit of improvement. We have randomized controlled trials showing that these drugs work.

mrosett 7y ago

Re: cost - you're conflating two different things. The cost of new drugs at the time of introduction has gone up. The new drugs of 2020 are more expensive than the new drugs of 2000. However, with a few high-profile exceptions, the cost of any individual drug goes down over time once generics are introduced. The expensive new drugs of today are the affordable generics of tomorrow. Biologics are genuinely expensive to manufacture, so the cost of the current generation of immunotherapies will remain substantial, but it will ultimately drop to a fraction of what it is today. Re: survival benefits - population level data about overall survival is tricky to get right, and issues like earlier detection leading to longer measured survival without actual benefit are real. And I'm sure that if you tweak the statistics just right, you can argue that all of the advances of the last 50 years have accomplished nothing. But that ignores a hugely important fact: we have randomized controlled trials showing that people who get these drugs live longer than an identical population that doesn't get them. I was going to spend a while finding citations, but let's go with the comment /u/dannykwells just posted: "This article is absolute 100% bullshit. -Metastatic melanoma: used to be lethal, now 50% cure rate.[1] -Non small cell lung cancer: same, now around 25% [2] -Breast cancer used to have a terrible prognisis, now 75% survive. [3] -Not to mention the myriad of blood cancers with new, strong, cell therapy treatment options with 40-50% durable cure rate. I don't know this person, but seriously, whoever he is, fuck you dude. Millions of us work day and night trying to improve care, and 99% of us arent getting rich. [1] https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 https://www.nejm.org/doi/full/10.1056/NEJMoa1709684 [2] https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 https://www.nejm.org/doi/full/10.1056/NEJMoa1801946 [3] https://www.breastcancer.org/research-news/20100930" https://www.breastcancer.org/research-news/20100930"