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My wife (a senior consultant, and director of medicine at a major Australian hospital) took her sabbatical at Stanford Medicine in part because of the elevated

My wife (a senior consultant, and director of medicine at a major Australian hospital) took her sabbatical at Stanford Medicine in part because of the elevated level of stage IV cancer presentation in the US. Key quote: "these are cases we hardly ever get to see at home". The financial disincentive to seek care is strong.

MattGaiser 6y ago
This should be the follow up study. Are there higher rates of higher state cancer in America and do they correlate with access to health insurance?
- spaetzleesser 6y ago
  I think people are waiting too long. And hospitals are probably not unhappy with that. I bet there is way more money in late stage cancer treatments vs early stage.
  - cced 6y ago
    When your system would rather make money from your treatment of stage 4 cancer than benefit from a healthy and cured stage 1 cancer survivor. I’m happy my taxes go towards helping people get out of stage 1 than seeing people live their final days in stage 4.
    - xtracto 6y ago
      Exactly, that's one reason why government paid social health care is aligned with this: The government benefits from doing prevention programmes as it is cheaper than late treatment. Germany had all kind of preventative help/medicine when I lived there.
      - refurb 6y ago
        Why would a private insurer not have the same incentive? Collect full premiums, but overall lower costs with early detection and treatment?
        mbg721 6y ago
        The older and sicker patients tend to move from the private insurer's risk pool to the public one.
        refurb 6y ago
        Agreed. But there is still an incentive for private insurers to limit future costs.
    - Gibbon1 6y ago
      The US system hopes that people get untreatable stage 4 cancer and die quickly.
      - spaetzleesser 6y ago
        Maybe the insurers. Hospitals prefer treating them in the most expensive way.
        Gibbon1 6y ago
        Heard the Chair of the Department of Medicine at UCSF say they make most of their money on elective procedures.
floatingatoll 6y ago
To restate this for US folks who aren’t familiar with cancer - The reason they rarely get to see stage 4 cancer in Australia is because their health care system would rather treat it when it’s at stage 1, and patients are able to seek that treatment without fear of bankruptcy; but in the US, public health care isn’t generally available until you’re 65, leading to a huge spike in “I couldn’t afford to see a doctor sooner” stage 4 cancers. EDIT: Please do review the replies below, as they offer legitimate questions/doubts about my comment.
- chimeracoder 6y ago
  > The reason they rarely get to see stage 4 cancer in Australia is because their health care system would rather treat it when it’s at stage 1, and patients are able to seek that treatment without fear of bankruptcy; but in the US, public health care isn’t generally available until you’re 65, leading to a huge spike in “I couldn’t afford to see a doctor sooner” stage 4 cancers. That explanation fits what people probably expect, but it's not borne out by the data. The US actually has a higher 5-year survival rate for most common treatable cancers than Australia (e.g. breast cancer, colorectal cancer, prostate cancer). This has been confirmed by multiple multi-year studies that analyze cancer survival rates across countries (e.g. https://pubmed.ncbi.nlm.nih.gov/29395269/ https://pubmed.ncbi.nlm.nih.gov/29395269/)
  - floatingatoll 6y ago
    My comment doesn't discuss survival rates at all. Perhaps there has been a misunderstanding? I said that, for Australia's health care system, treating cancer at Stage 1 is cheaper than treating it at Stage 4. Could you talk more about how you went from treatment costs to survival rates? EDIT: I didn't state that clearly enough in my original comment. I'll leave it unedited and let this reply serve as clarification.
    - sxg 6y ago
      The other commenter is pointing out the flaw in your argument. You're claiming that Australians are less likely to see stage IV cancer than Americans due to a worse healthcare system in America. As the other commenter states, that's a very believable argument that fits the narrative about America's healthcare system. However, the data doesn't support that claim. If Australians truly see fewer cases of stage IV cancer because of a better healthcare system, then we should expect to see higher 5-year survival rates for those cancers in Australia. As the other commenter brought up, 5-year survival rates are higher in America than Australia for the most common cancers. So it's unlikely that your original argument is correct. Sure, America's healthcare system is deeply flawed, but it's important to attack it on fair grounds. We can't solve a systemic issue by raising claims and arguments that aren't supported by evidence. EDIT: Furthermore, identifying early stage cancer is an extremely problematic and difficult field regardless of healthcare system and country. In America, we currently screen asymptomatic healthy adults for breast cancer and colon cancer. We screen people with a smoking history for lung cancer. However, the benefits to overall mortality of these cancer screening tests is controversial. While in theory identifying stage I cancer should result in improved overall mortality, the data doesn't clearly show that. Take a look at length-time bias (https://en.wikipedia.org/wiki/Length_time_bias https://en.wikipedia.org/wiki/Length_time_bias). It's possible that a substantial portion of the cancer screening that's done in America (and the stage I cancers found in Australia) selectively identify indolent cancers that are unlikely to be harmful to patients.
refurb 6y ago
Maybe there is a piece of info missing but this comment had my bullshit detector going off big time. There are plenty of stage IV cancers in Australia. There is no screening for lung cancer so 80% in Australia are stage IV. Even with screening 20% of colon cancer in Australia is stage IV.[1] Plus California has more people than all of Australia and the worst cancer patients try to go to Stanford, so if expect huge numbers (more than all of Australia even if rates were similar). [1]https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/incidence-and-survival-by-stage https://www.aihw.gov.au/reports/cancer/cancer-data-in-austra...
- inopinatus 6y ago
  Do the arithmetic: according to that very reference, the Australian stage-IV-at-diagnosis statistic for lung cancer is not 80% but 42%, and it seems this is unchanged since 2011 [1]; notwithstanding which, cherry-picking lung cancer (notorious for late presentation) hardly invalidates the much more general observation being made. [1] https://ncci.canceraustralia.gov.au/features/national-cancer-stage-diagnosis-data https://ncci.canceraustralia.gov.au/features/national-cancer...
  - refurb 6y ago
    It's only 42% because ~30% isn't even staged (those might or might not be stage 4). Drop that and 80% is stage 4. And no, a general observation of "we don't see stage 4 cancers in Australia, we have to go to the US" is clearly invalidated by this data. There are plenty of stage 4 cancers in Australia. Take a look at the US Seer data it appears more is diagnosed earlier in the US.[1] 50% are not stage IV and only 2% are unstaged. [1]https://seer.cancer.gov/ https://seer.cancer.gov/
    - inopinatus 6y ago
      No-one said "we don't see stage 4 cancers in Australia", so I'm afraid your so-called "bullshit detector" is broken. On the other hand: intentionally misrepresenting people's statements, and crudely and inappropriately manipulating statistics, sets off my bullshit detector.
MauroIksem 6y ago
My boss less than a couple of years ago died of stage 4 cancer in his early 40s. Apparently didn't notice symptoms until it was too late and died within six months of diagnosis.
snarf21 6y ago
There is only one problem with healthcare in the US: misaligned incentives. Medicare would likely save money by having free screenings and yearly bloodwork for all Americans starting at say age 40. The cost of some of these experimental cancer drugs is very very high not to mention surgery/chemo/radiation/etc. Additionally, it would create more incentives to find cheaper/faster/newer tests for these diseases knowing that there will be a HUGE market for them forever. My guess is that after some small number of years, this would actually save Medicare money. Obviously, there is the human upside as well.
nilpunning 6y ago
According to the World Health Organization these are the cancer mortality statistics comparing US to Australia. US Number of deaths: 612,390 Crude rate: 185.0 ASR (World) per 100,000: 86.3 Cumulative risk (0-74): 0 Australia Number of deaths: 48,236 Crude rate: 189.2 ASR (World) per 100,000: 83.3 Cumulative risk (0-74): 0 These numbers seem fairly close, while other countries have much larger differences. The Australia numbers for incidences are higher, perhaps indicating that they catch it earlier or their population suffers from a naturally higher incidence rate, but that does not equate to significantly lower mortality. Source: https://gco.iarc.fr/ https://gco.iarc.fr/

MattGaiser 6y ago

This should be the follow up study. Are there higher rates of higher state cancer in America and do they correlate with access to health insurance?

spaetzleesser 6y ago
I think people are waiting too long. And hospitals are probably not unhappy with that. I bet there is way more money in late stage cancer treatments vs early stage.
- cced 6y ago
  When your system would rather make money from your treatment of stage 4 cancer than benefit from a healthy and cured stage 1 cancer survivor. I’m happy my taxes go towards helping people get out of stage 1 than seeing people live their final days in stage 4.
  - xtracto 6y ago
    Exactly, that's one reason why government paid social health care is aligned with this: The government benefits from doing prevention programmes as it is cheaper than late treatment. Germany had all kind of preventative help/medicine when I lived there.
    - refurb 6y ago
      Why would a private insurer not have the same incentive? Collect full premiums, but overall lower costs with early detection and treatment?
      - mbg721 6y ago
        The older and sicker patients tend to move from the private insurer's risk pool to the public one.
        refurb 6y ago
        Agreed. But there is still an incentive for private insurers to limit future costs.
  - Gibbon1 6y ago
    The US system hopes that people get untreatable stage 4 cancer and die quickly.
    - spaetzleesser 6y ago
      Maybe the insurers. Hospitals prefer treating them in the most expensive way.
      - Gibbon1 6y ago
        Heard the Chair of the Department of Medicine at UCSF say they make most of their money on elective procedures.

floatingatoll 6y ago

To restate this for US folks who aren’t familiar with cancer - The reason they rarely get to see stage 4 cancer in Australia is because their health care system would rather treat it when it’s at stage 1, and patients are able to seek that treatment without fear of bankruptcy; but in the US, public health care isn’t generally available until you’re 65, leading to a huge spike in “I couldn’t afford to see a doctor sooner” stage 4 cancers. EDIT: Please do review the replies below, as they offer legitimate questions/doubts about my comment.

chimeracoder 6y ago
> The reason they rarely get to see stage 4 cancer in Australia is because their health care system would rather treat it when it’s at stage 1, and patients are able to seek that treatment without fear of bankruptcy; but in the US, public health care isn’t generally available until you’re 65, leading to a huge spike in “I couldn’t afford to see a doctor sooner” stage 4 cancers. That explanation fits what people probably expect, but it's not borne out by the data. The US actually has a higher 5-year survival rate for most common treatable cancers than Australia (e.g. breast cancer, colorectal cancer, prostate cancer). This has been confirmed by multiple multi-year studies that analyze cancer survival rates across countries (e.g. https://pubmed.ncbi.nlm.nih.gov/29395269/ https://pubmed.ncbi.nlm.nih.gov/29395269/)
- floatingatoll 6y ago
  My comment doesn't discuss survival rates at all. Perhaps there has been a misunderstanding? I said that, for Australia's health care system, treating cancer at Stage 1 is cheaper than treating it at Stage 4. Could you talk more about how you went from treatment costs to survival rates? EDIT: I didn't state that clearly enough in my original comment. I'll leave it unedited and let this reply serve as clarification.
  - sxg 6y ago
    The other commenter is pointing out the flaw in your argument. You're claiming that Australians are less likely to see stage IV cancer than Americans due to a worse healthcare system in America. As the other commenter states, that's a very believable argument that fits the narrative about America's healthcare system. However, the data doesn't support that claim. If Australians truly see fewer cases of stage IV cancer because of a better healthcare system, then we should expect to see higher 5-year survival rates for those cancers in Australia. As the other commenter brought up, 5-year survival rates are higher in America than Australia for the most common cancers. So it's unlikely that your original argument is correct. Sure, America's healthcare system is deeply flawed, but it's important to attack it on fair grounds. We can't solve a systemic issue by raising claims and arguments that aren't supported by evidence. EDIT: Furthermore, identifying early stage cancer is an extremely problematic and difficult field regardless of healthcare system and country. In America, we currently screen asymptomatic healthy adults for breast cancer and colon cancer. We screen people with a smoking history for lung cancer. However, the benefits to overall mortality of these cancer screening tests is controversial. While in theory identifying stage I cancer should result in improved overall mortality, the data doesn't clearly show that. Take a look at length-time bias (https://en.wikipedia.org/wiki/Length_time_bias https://en.wikipedia.org/wiki/Length_time_bias). It's possible that a substantial portion of the cancer screening that's done in America (and the stage I cancers found in Australia) selectively identify indolent cancers that are unlikely to be harmful to patients.

refurb 6y ago

Maybe there is a piece of info missing but this comment had my bullshit detector going off big time. There are plenty of stage IV cancers in Australia. There is no screening for lung cancer so 80% in Australia are stage IV. Even with screening 20% of colon cancer in Australia is stage IV.[1] Plus California has more people than all of Australia and the worst cancer patients try to go to Stanford, so if expect huge numbers (more than all of Australia even if rates were similar). [1]https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/contents/incidence-and-survival-by-stage https://www.aihw.gov.au/reports/cancer/cancer-data-in-austra...

inopinatus 6y ago
Do the arithmetic: according to that very reference, the Australian stage-IV-at-diagnosis statistic for lung cancer is not 80% but 42%, and it seems this is unchanged since 2011 [1]; notwithstanding which, cherry-picking lung cancer (notorious for late presentation) hardly invalidates the much more general observation being made. [1] https://ncci.canceraustralia.gov.au/features/national-cancer-stage-diagnosis-data https://ncci.canceraustralia.gov.au/features/national-cancer...
- refurb 6y ago
  It's only 42% because ~30% isn't even staged (those might or might not be stage 4). Drop that and 80% is stage 4. And no, a general observation of "we don't see stage 4 cancers in Australia, we have to go to the US" is clearly invalidated by this data. There are plenty of stage 4 cancers in Australia. Take a look at the US Seer data it appears more is diagnosed earlier in the US.[1] 50% are not stage IV and only 2% are unstaged. [1]https://seer.cancer.gov/ https://seer.cancer.gov/
  - inopinatus 6y ago
    No-one said "we don't see stage 4 cancers in Australia", so I'm afraid your so-called "bullshit detector" is broken. On the other hand: intentionally misrepresenting people's statements, and crudely and inappropriately manipulating statistics, sets off my bullshit detector.

MauroIksem 6y ago

My boss less than a couple of years ago died of stage 4 cancer in his early 40s. Apparently didn't notice symptoms until it was too late and died within six months of diagnosis.

snarf21 6y ago

There is only one problem with healthcare in the US: misaligned incentives. Medicare would likely save money by having free screenings and yearly bloodwork for all Americans starting at say age 40. The cost of some of these experimental cancer drugs is very very high not to mention surgery/chemo/radiation/etc. Additionally, it would create more incentives to find cheaper/faster/newer tests for these diseases knowing that there will be a HUGE market for them forever. My guess is that after some small number of years, this would actually save Medicare money. Obviously, there is the human upside as well.

nilpunning 6y ago

According to the World Health Organization these are the cancer mortality statistics comparing US to Australia. US Number of deaths: 612,390 Crude rate: 185.0 ASR (World) per 100,000: 86.3 Cumulative risk (0-74): 0 Australia Number of deaths: 48,236 Crude rate: 189.2 ASR (World) per 100,000: 83.3 Cumulative risk (0-74): 0 These numbers seem fairly close, while other countries have much larger differences. The Australia numbers for incidences are higher, perhaps indicating that they catch it earlier or their population suffers from a naturally higher incidence rate, but that does not equate to significantly lower mortality. Source: https://gco.iarc.fr/ https://gco.iarc.fr/