Prescribing Taxotere

With many illnesses, the process of prescription and treatment is fairly straightforward. A patient goes to their primary physician, describes their complaints, and the doctor diagnoses them and might prescribe medication. Perhaps a nurse takes their blood pressure and basic statistics or an intern helps the doctor draw blood, but the primary relationship is between the physician and the patient.

When cancer is suspected, the process becomes infinitely more complicated, and patients become exposed to a variety of systems designed to diagnose, treat, and support individuals with the disease. Every case of cancer is different and may require the participation of different medical professionals who work together to provide care for the patient.

Cancer Specialists

If patients either suspect cancer or present with symptoms that are indicative of cancer, they usually still visit their primary care physician or an urgent care doctor first. If the doctor suspects cancer, they will either order blood tests and imaging or refer the patient to another facility that is better equipped to diagnose their disease. After a patient is diagnosed, they are almost always referred to a cancer specialist, known as an oncologist, who then guides the rest the patient through their treatment plan.

Because there are so many fields of treatment for cancer, there are multiple kinds of oncologists with different specialties. Patients may be referred to or interact with

• Radiation oncologists, who specialize in treating cancer with radiation therapy
• Surgical oncologists, who focus on surgical tumor removal techniques and certain kinds of biopsies
• Chemical oncologists, who advise on chemotherapy and related drug prescription and administration
• Gynecologic oncologists, who treat gynecologic cancers such as uterine, cervical, and ovarian cancer
• Pediatric oncologists, who specialize in treating children with cancer
• Hematologist-oncologists, who work with specific cancers of the blood, such as leukemia and lymphoma

If a patient’s cancer case is unique or particularly difficult in some way, the primary oncologist might choose to send the case to a group of cancer specialists known as a “tumor board.” This group can collectively review the information and make recommendations to the primary oncologist about treatment options using their combined knowledge and expertise.

Often, cancer patients will require multiple methods of treatment and will, therefore, consult with many different oncologists. This group of medical advisors, along with the other medical staff who might assist a patient during the course of their disease, is known as a cancer care team. This team may consist of a combination of many caretakers including an

• Oncology Nurse: this person specializes in the treatment and care of patients with cancer, providing exams, educating patients and families, and often administering chemotherapy
• Patient Navigator: this individual helps a patient with cancer gain access to resources, assists them in overcoming financial, social, or logistical barriers, and may organize and coordinate the many pieces of a patient’s medical care.
• Oncology Social Worker: similarly to a patient navigator, an oncology social worker focuses on the patient’s mental and social health during the treatment of cancer, helping to ensure child care services, support groups, and other community resources.
• Rehabilitation Therapists: a cancer patient may work with multiple rehabilitation therapists to regain movement, strength, flexibility, independence and speech after surgery and extensive chemotherapy treatments.
• Palliative Care Professionals: these can be either doctors or nurses who specialize in the prevention and treatment and alleviation of symptoms or side effects of both cancer and the treatments of chemotherapy, radiation, and surgery

Many of these people choose to specialize in the treatment of cancer, and some become even more specialized to only treat one kind of cancer, such as breast cancer, or one particular variation of one kind of cancer. These are just a few of the many professionals a cancer patient might interact with during the time of their diagnosis, treatment, and eventual recovery. Other people that might provide treatment, care, information, or comfort include physician assistants (PAs), nurse practitioners (NPs), pathologists, dieticians, diagnostic radiologists, home health aides, pharmacists, and religious representatives such as a chaplain.

Prescribing Chemotherapy

Many cancer patients are lucky enough to have the support of many kind and invested medical and non-medical professionals. The oncologist, however, generally decides the course of treatment, then recommends and prescribes the particular chemotherapy drugs that they believe will work most effectively in a patient’s particular case. Other professionals will follow the general leadership of the oncologist or group of oncologists who are reviewing and directing a patient’s case.

Getting a Second Opinion

Often, cancer support networks advise that patients get a second opinion about their treatment plan if they feel concerned or believe there could be other options that their doctor is not considering or presenting clearly. Alternatively, even if a patient feels comfortable with their doctor’s recommendations, another doctor might catch something different in the pathology report or know of a different study or clinical trial that may influence a patient’s course of treatment. If a doctor presents a patient with multiple options for their treatment, a second opinion can possibly help a patient make a clear and informed decision. Also, sometimes doctors have predilections or biases towards or against certain treatment options or chemotherapy drugs based on personal experience, hospital politics, or even personal kickbacks. Consulting another medical professional can help a patient to recognize and avoid these biases.

Profiting from Chemotherapy

As the rate and incidence of all kinds of cancer grow in the United States, chemotherapy drugs are at once becoming more sophisticated and more expensive. The demand for these drugs is higher than ever; however, as more pharmaceutical companies become financially invested in developing more specialized drugs and more options become available on the market, companies must compete to market their particular drug to hospitals, doctors, and patients. Although the company may receive FDA approval for the safety of their drug, fully testing them takes hundreds of patients and years or even decades to thoroughly comprehend the long-term viability of each compound. Survival rates for patients between two competing drugs may differ by months or years, even though initial success appears identical.

Drug marketing is a contentious and morally fraught topic. Pharmaceuticals must make money to create and manufacture new drugs, so they must have customers. Doctors and practices, even if they are nonprofits, must create a profit in order to invest in new medical and technological developments and provide cutting edge care to their patients. Unfortunately, these pressures sometimes allow flashy marketing, kickbacks to doctors from pharmaceuticals, and profit from selling a brand name drug, to come before a patient’s medical needs.

Doctors and hospitals can make a substantial profit on chemotherapy drugs if they choose to prescribe unnecessary or particularly expensive brand-name drugs instead of cheaper generic alternatives. Prescribing unnecessary drugs is illegal, but the boundaries between necessary and unnecessary medication can be murky, especially when the research is still forthcoming. Some smaller practices cannot sustain their businesses by selling generic drugs and are therefore forced to either prescribe more expensive alternatives or go under and join larger, corporate practices. Larger hospitals might even unofficially encourage doctors to prescribe more complicated drug regimens, expensive experimental treatments, or certain brand name drugs to increase the hospital’s profit.

In the case of Taxotere, there is an alternative drug called Taxol which is only slightly chemically different from Taxotere. It is possible that the marketing techniques by Sanofi-Aventis, the producer of Taxotere, encouraged its preferential use over Taxol without substantial evidence as to its increased effectiveness. In addition, Taxotere is known to cause permanent hair loss in up to 15% of patients who receive the drug, a common side effect that was not listed on the original FDA label despite early evidence in clinical trials and extensive anecdotal support. It is possible that breast cancer patients, in particular, were given an unnecessary drug which caused permanent disfigurement for the increased profit of doctors, hospitals, and, in particular, pharmaceutical companies.