Of course you know that cancer chemotherapy can make you lose your hair. Fingers and toes may become painful or numb. Your immune system, especially the white blood cells, may be destroyed. But did you know that sometimes chemo kills?
Other websites may tell you that chemo is dangerous. But this report may be the first time that anyone has shown the general public that chemo kills, with reference to peer-reviewed studies.
Is Chemo Really “Palliative”?
Palliation means relief of pain or other symptoms, without dealing with the cause of the condition. The word derives from pallium, which is Latin for cloak.Many studies refer to the chemo given at the end of life as “palliative treatment.” This type of chemo is meant to cloak symptoms of the disease itself.
In an excellent You Tube video, the Israeli palliative care specialist, Dr. Nathan I. Cherny, MD, has said that “there comes a point where the disease is essentially resistant to further treatment and administration of further treatment is more likely to harm than to help.“
According to Dana-Farber Cancer Center scientists:
“Patients with cancer who die soon after starting chemotherapy incur costs of treatment without the benefits….These patients experience burdensome symptoms without many of the potential benefits of chemotherapy.”
In fact, a certain percentage of patients die as a direct result of the chemo itself.
In 2015, Prof. Holly Prigerson, along with 11 co-authors, published an important paper on the topic. They concluded that chemo given to improve symptoms actually worsened the quality of life (QOL) of many of those who received it. Patients who had a good performance status sickened. And those who already had a poor to moderate performance status did not improve. In fact, sometimes the chemo that was meant to give them relief killed them off sooner.
Prigerson is a professor at Weil Cornell Medical College and Harvard Medical School, and her co-authors are all professors at Columbia, Yale, Duke, Michigan, etc. Her report in JAMA Oncology created a bit of a stir in medical circles. To date, it has been referenced 200+ times in other journal articles (an indication of its impact).
In this paper, they spoke in unusually direct terms for academics:
Yet, aside from a few blogs or specialized websites, there was a virtual news blackout on this major study on the futility of palliative chemo. It had intrinsic merit. But reporters shied away from the topic, probably because it is depressing to learn that a major form of therapy is so counterproductive.
Difficulty Researching This Topic
There is in fact a systematic bias in the reporting of negative effects of chemo. To illustrate the problem, a PubMed search of the words benefit of cancer chemotherapy returned 22,645 citations to research papers. But a search of the words harm of cancer chemotherapy returned just 261 such citations, about 1% of the positive ones!
Many factors cause this extreme disparity. But you don’t have to be a conspiracy theorist to realize that the medical system, and the mainstream media, shy away from bad news about favored and profitable treatments. The pharmaceutical industry exerts its influence in a thousand ways, subtle and obvious, and this is one of them.
In addition, critical articles appear in journals where access is limited to those willing to pay for even temporary access. Thus, to have 24 hours of access to the aforementioned article in Lancet Oncology, you are required to pay US $31.50. This can add up if you need to see multiple articles. But doctors usually have access to articles for free through their home institutions. So the public is at a disadvantage in getting the information it needs to make an informed decision. It is more reliant on the words of doctors and other professionals, who may have a bias in favor of conventional medicine.
How Accurate Is the Reporting?
There is also a strong bias built into research on chemo’s side effects. That is because doctors get to assess the effects of the treatments they give. And, of course, they have a professional interest in not admitting their own mistakes and failures. Sometimes they have an economic interest as well, if they are paid consultants and advisors to the companies that own these treatments.
One palliative care specialist, Nathan I. Cherny, MD, has said that journal editors and peer reviewers routinely accept the statistics provided by the doctors who give the treatment. But nobody thinks to ask the patients or their relatives what they themselves experienced in the course of treatment.
“A significant number of [clinical] trials…in recent years show suboptimal reporting of adverse events, particularly the reporting of recurrent or late toxicities and the duration of the adverse events….”
And according to a scientist at the National Cancer Institute of Italy:
“More than 90% of trials scored poorly in their reporting of recurrent and late toxicities, and in reporting the duration of adverse events…[This] consistently leads to underreporting of adverse events and the severity of those events.”
For all these reasons, we need to take most published reports of chemo’s side effects with a grain of salt. Doctors have a vested reason to underreport the toxicity of the treatments they give. They rarely publish reports showing that chemo kills. When they do, they still understate the extent of the problem, or use language that masks the actual impact of the treatment.
Severe or Life-Threatening
In this report, we shall focus on deaths that are part of the side effects of chemotherapy. However, we need to put this in its proper context. Death is only the most extreme harm that comes to patients. But there are many other serious harms that stop short of killing the patient.
For instance, in 2018 there was a comprehensive study of clinical trials of chemo in children with cancer. It was a systematic review and a meta-analysis of the topic. A meta-analysis, according to the NCI Cancer Dictionary, is:
“A process that analyzes data from different studies done about the same subject. The results of a meta-analysis are usually stronger than the results of any study by itself.”
There were some astonishing findings in this study. Among the 4,604 children who received chemo in 170 clinical trials, there were 4,675 grade 3 and 4 adverse events. That averages out to more than one such incident per child.
What exactly does this mean? The NCI divided side effects into five grades::
- Grade 1, Mild; intervention is not necessary.
- Grade 2, Moderate: minimal, local, or noninvasive intervention.
- Grade 3, Severe, medically significant but not life-threatening.
- Grade 4, Life-threatening: urgent intervention indicated.
- Grade 5, Death related to the adverse event.
So, according to the NCI’s own classification system, grade 3 and 4 side effects (such as were seen in this study) means they were “severe,” “disabling,” “life-threatening,” and/or required “urgent intervention.”
Yet, for all that suffering, the objective response rate (ORR) among the 3,569 children who had solid tumors (as opposed to leukemias) was just 3.17 percent.
Hard to believe, isn’t it? Three out of a hundred experienced some shrinkage of their tumor. (This doesn’t necessarily mean their lives were prolonged). But almost all of them suffered severe side effects. And, overall, 2.09% of them died from the side effects of the chemo.
As the authors themselves summarized:
So when we talk about death from chemo we are only talking about the tip of an enormous iceberg, which is the considerable pain and suffering caused by the treatment itself.
Scientific writing is difficult for laypeople to understand. It is writing in an obscure jargon, a kind of code. Some of this is the necessary shorthand that exists in communication between all professionals. But some of it is pure obscurantism.
In scientific writing, for instance, doctors may use euphemisms that obscure the bad effects of chemo. For example, they may obscure a chemo death by calling it a “grade 5 adverse event,” or even just a “G5” event. The purpose may be to facilitate communication among professionals. But, at the same time, no layperson who happens upon such a paper is likely to understand what it means. Here is an example:-
What this paper actually shows is that many patients sickened and one even died after getting this toxic treatment. But, in their conclusions, the authors say absolutely nothing about this, but claim that the treatment was “feasible.”
Another problem is when doctors lump together the more serious side effects as “grade 3-5 adverse events.” That way, the actual number of people who died as a result of treatment usually cannot be determined. Thus, in a 2019 study of three cancer drugs at the Cleveland Clinic, the authors state:
“Grade 3-5…toxicity was seen in 10 patients, and 4 (30%) were hospitalized with pulmonary toxicity possibly related to study drugs.”
The authors do recommend against the use of this combination, due it its “excessive toxicity.” But the deaths from this particular drug combination are hidden within the broader category of “grade 3-5 toxicity.”
In the last few decades, there have been some studies on the fatal effects of chemotherapy. But this raises the important question of how one knows that a death was caused by the chemo, and not by other causes, including of course the disease itself.
The truth is, there is no way to know for sure. Cancer patients can get myriad symptoms. Chemo may also cause many of the same symptoms. How can you tell the two apart? As a result, increasingly, instead of trying to nail down the exact cause of death in every instance, scientists have looked at how quickly people have died after receiving treatment.
In particular, they have looked at how many died within 30 days of receiving chemotherapy. If patients die within one month, then it is likely that they did so as a result of the chemo, and not of the cancer or some other unrelated disease.
It may be objected that this method does not prove that they died of the chemo. So doesn’t it exaggerate the number of chemo deaths? Actually, this method probably underestimates the number of chemo deaths. For it does not take into account patients who die 31 days or more after starting chemo.
In addition, chemo “can also cause side effects that don’t become evident until months or years after treatment,” to quote the Mayo Clinic website.
So people who dies of, say, kidney failure 31 days, or 310 days, after starting chemo, would have their deaths listed as renal disease, with no mention of their prior drug treatment. This is another way that doctors may underestimate the real impact of toxic drugs on mortality, especially at the end-of-life.
Don’t Alarm the Public
Usually stories on chemo that appear in the mass media are meant to soothe the anxiety of the general population. But occasionally the unvarnished truth manages to breaks through. This is what happened when The Telegraph, one of Britain’s ”big three quality newspapers,” uncovered facts about chemo deaths at various British hospitals.
The Telegraph’s headline boldly read:
“Chemotherapy warning as hundreds die from cancer-fighting drugs”
Their science editor, Sarah Knapton, then wrote a lead paragraph that you are unlikely to read in any U.S. paper:
What’s Going on in Milton Keynes?
The 50% figure referred to in this article is a peculiar situation in Milton Keynes. This is a “new town” about one hour’s drive from London. There,
“The death rate for lung cancer treatment [there] was 50.9%, although it was based on a very small number of patients…. Similarly, around one in five people (20%) who underwent palliative care for breast cancer at Cambridge University Hospitals died from their treatment.”
(To see the complete breakdown of study statistics click here.)
This Moss Report shows, with reference to the standard medical literature, that chemotherapy kills a certain portion of the patients who take it. It is especially dangerous when used as part of palliative care. Chemotherapy of course has many uses. It is absolutely indispensable in treating childhood leukemias, for instance.
But there is a general tendency in writings intended for the public to overstate the benefit and to understate the harm that this dangerous and often ineffective treatment can do. It is only by having a realistic assessment of the pluses and minuses of conventional methods that the public will be motivated to demand a more humane kind of treatment. And that, after all, is the shared goal of everyone who treats this terrible disease.