3 ms·

Maybe I've misunderstood, but for the average person that's even worse news, right? Two months was from clinical trials where there's no doubt that the "thumb

Maybe I've misunderstood, but for the average person that's even worse news, right? Two months was from clinical trials where there's no doubt that the "thumb is on the scale" in a host of ways, creating an exaggerated estimate of efficacy that would be realised in the real world. The reality is closer to no life extension, with the remaining lifespan is spent sicker than you'd have been without the drugs.

icegreentea2 3y ago
Imagine a toy scenario where a cancer will kill 80% of people with it at exactly 3 years, and all 20% remaining will uh live full lives (so say another 20 years). If you created a drug that shifted the ratio to 60/40, and measured right at the 5 year mark. In a population of 100 untreated people, you'd get like 4080 total months lived (80x36 + 20x60). In a population of 100 treated people, you'd get like 4560 months lived (60x36+40x60). That's only generating an extra 4.8 months of life per person treated. However, you've doubled the number of people alive at the end of trial. Now obviously this is a toy example that's probably a bit exaggerated, but this type of behavior is exactly why median/average life extension is an inadequate measure alone.
s1artibartfast 3y ago
>The reality is closer to no life extension, with the remaining lifespan is spent sicker than you'd have been without the drugs. I dont think that is true at all. The data is pretty clear that lifespan is significantly increasing. >Over time, the mean overall survival has improved from two months in 1973 to five months in 2015. Regarding long-term survival, a clear rise in 2yS is noted, increasing from 2.6% in 1973 to 12.9% in 2013 (latest year of which 2yS data can be calculated; Figure 1 and Tables 1 and 2), occurring mostly after the mid-1990s. A more modest increase is seen in the 5yS, from 0.7% in 1973 to 3.2% in 2010. >https://www.researchgate.net/publication/348455938_Long-Term_Survival_of_Patients_with_Metastatic_Non-Small-Cell_Lung_Cancer_over_Five_Decades https://www.researchgate.net/publication/348455938_Long-Term...
- pauln99 3y ago
  I'm sorry, but two months to five months after 50 years and hundreds of billions of dollars. That was hardly the promise of the "war on cancer"!
  - s1artibartfast 3y ago
    To be fair, there are other cancers that are essentially cured. Lung cancer is a particularly nasty one for a number of reasons. It's hard to fight with the laws of physics or biology, so I'm curious who promised you something else. In general though, I tend to agree that in the US we spend far too much on what essentially boils down to performative end of Life Care. If you ask someone if they would rather spend $200k for 2 months or leave it to their family, I think most people would pick the second option. When someone else is paying, they choose the first option.
    - pauln99 3y ago
      "This year marks the 50th anniversary of the “War on Cancer” declared by Richard Nixon, a former President of the United States of America. By signing into law the National Cancer Act on December 23, 1971, Nixon hoped this action to be the landmark legislation taken by his administration. Nixon apparently had confidence that cancer would be conquered in 5 years." You're right, there are a small handful of unusual cancers that we have cures for, and that's great. And some small progress has been made overall. But a lot of money has been spent, and it has been half a century or more, and we don't have much to show for our efforts.
      - acdha 3y ago
        > You're right, there are a small handful of unusual cancers that we have cures for, and that's great. And some small progress has been made overall. But a lot of money has been spent, and it has been half a century or more, and we don't have much to show for our efforts. Yes, it would be better if we had more complete treatments but it’s far from nothing. I have a friend who was given 6 months to live a couple decades ago, right before a treatment for his not especially rare cancer was approved. He didn’t expect to see his daughter leave elementary school but is still around for her post college career – and as a scientist himself is keenly aware of how much hard work made that possible. We can simultaneously acknowledge that progress has been made but cancer is one of the hardest problems humanity has tackled.

icegreentea2 3y ago

Imagine a toy scenario where a cancer will kill 80% of people with it at exactly 3 years, and all 20% remaining will uh live full lives (so say another 20 years). If you created a drug that shifted the ratio to 60/40, and measured right at the 5 year mark. In a population of 100 untreated people, you'd get like 4080 total months lived (80x36 + 20x60). In a population of 100 treated people, you'd get like 4560 months lived (60x36+40x60). That's only generating an extra 4.8 months of life per person treated. However, you've doubled the number of people alive at the end of trial. Now obviously this is a toy example that's probably a bit exaggerated, but this type of behavior is exactly why median/average life extension is an inadequate measure alone.

s1artibartfast 3y ago

>The reality is closer to no life extension, with the remaining lifespan is spent sicker than you'd have been without the drugs. I dont think that is true at all. The data is pretty clear that lifespan is significantly increasing. >Over time, the mean overall survival has improved from two months in 1973 to five months in 2015. Regarding long-term survival, a clear rise in 2yS is noted, increasing from 2.6% in 1973 to 12.9% in 2013 (latest year of which 2yS data can be calculated; Figure 1 and Tables 1 and 2), occurring mostly after the mid-1990s. A more modest increase is seen in the 5yS, from 0.7% in 1973 to 3.2% in 2010. >https://www.researchgate.net/publication/348455938_Long-Term_Survival_of_Patients_with_Metastatic_Non-Small-Cell_Lung_Cancer_over_Five_Decades https://www.researchgate.net/publication/348455938_Long-Term...

pauln99 3y ago
I'm sorry, but two months to five months after 50 years and hundreds of billions of dollars. That was hardly the promise of the "war on cancer"!
- s1artibartfast 3y ago
  To be fair, there are other cancers that are essentially cured. Lung cancer is a particularly nasty one for a number of reasons. It's hard to fight with the laws of physics or biology, so I'm curious who promised you something else. In general though, I tend to agree that in the US we spend far too much on what essentially boils down to performative end of Life Care. If you ask someone if they would rather spend $200k for 2 months or leave it to their family, I think most people would pick the second option. When someone else is paying, they choose the first option.
  - pauln99 3y ago
    "This year marks the 50th anniversary of the “War on Cancer” declared by Richard Nixon, a former President of the United States of America. By signing into law the National Cancer Act on December 23, 1971, Nixon hoped this action to be the landmark legislation taken by his administration. Nixon apparently had confidence that cancer would be conquered in 5 years." You're right, there are a small handful of unusual cancers that we have cures for, and that's great. And some small progress has been made overall. But a lot of money has been spent, and it has been half a century or more, and we don't have much to show for our efforts.
    - acdha 3y ago
      > You're right, there are a small handful of unusual cancers that we have cures for, and that's great. And some small progress has been made overall. But a lot of money has been spent, and it has been half a century or more, and we don't have much to show for our efforts. Yes, it would be better if we had more complete treatments but it’s far from nothing. I have a friend who was given 6 months to live a couple decades ago, right before a treatment for his not especially rare cancer was approved. He didn’t expect to see his daughter leave elementary school but is still around for her post college career – and as a scientist himself is keenly aware of how much hard work made that possible. We can simultaneously acknowledge that progress has been made but cancer is one of the hardest problems humanity has tackled.