Bargaining with cancer patients about treatment

When a doctor and a patient discuss treatments, is it a conversation or a negotiation?

Surgeons at Memorial Sloan Kettering Cancer Center in New York are enlisting techniques taught at Harvard Business School to advise men facing tough decisions about prostate cancer.

Behfar Ehdaie liked giving his prostate-cancer patients hopeful news: While they had a low-grade version of the illness, they wouldn’t need immediate treatment, let alone major surgery. Instead, they could be monitored through a process known as active surveillance. But Dr. Ehdaie, a surgeon at Sloan Kettering, found that many men insisted on having radical surgery or radiation—treatments that sometimes had devastating side effects.

In recent years, a growing body of evidence indicates that men with low-grade early-stage prostate cancer don’t need radical treatment, such as removing or radiating the prostate. The medical consensus is that active surveillance often is the appropriate treatment for small early tumors. Yet despite the data showing that this approach is safe, about 50% of eligible men don’t get it either because they turn it down or their physicians don’t embrace it. Medical experts say many men have been overtreated, as their cancers probably posed little immediate danger.

David Miller, IHPI member and professor of urology at U-M, said Dr. Ehdaie is changing how doctors can talk to prostate-cancer patients. He wonders if the approach can work beyond Sloan Kettering. “The challenge is how do you bring Deepak Malhotra to care settings in rural parts of the United States,” he said. “What happens at Memorial isn’t necessarily what happens” in clinics across the country.