Paula Span

It should be left up to the patient. What are we trying to start a trend on not having surgeries because one is too old? I am not for this. I wonder if it's true with other illnesses and patients needing surgery

Not because of age, but because of poor health and frailty. The research, and the column based on it, is talking about women in nursing homes who have multiple illnesses and limited life expectancy. Not about healthy elders.

There are babies born frail. There are teenagers who become frail. Optimum health is not a straight line for the most of us. It depends on many factors. It's just to easy to make generalizations on people who are elderly and frail. It's complex.

Yes, very complex. i.e. many screenings and treatments don't benefit those with limited life expectancies. Nursing home residents are more likely to have those than babies and teens.

Damn it, it's not for you to say. What about those kids at Shriner's hospital? You have a very narrow view trying to convince all the world. Nursing home residents are just as human as everyone else. Who's to say what one's life expectancy is? Not you. Quality of life is personal

Quality of life: exactly the point. Often valued by elders over quantity. My column doesn't decide for anyone, young or old. It points out that women in nursing homes fare poorly after breast cancer surgery and that there are less aggressive options.

Please don't speak for all elders, speak for yourself. I see times coming when it will be the status quo not to treat people who have horrible illness against the odds. It will be too expensive... Not a good way to push forward. Young, old every life is precious.

If an old person has a problem why bother to consult doctor why do not we let them die ? This is hypocrisy Old men have penile implants, access to viagra & best medical care The patient should make the decision no procedure if that is what they want no biopsies Or surgery

Yes, patients should indeed make the decisions. But they need guidance. Some elders are better able than others to withstand aggressive interventions. One challenge for health care: to better discern and predict who will benefit, who will wish she hadn't undergone treatment.

Every patient is explained about risks complications surgeons are reluctant to operate on patients with co morbidities due to likely complications& death Treatment offered can be definitive or palliative no one size fits all & no way to predict how quickly a cancer will grow

Agreed. We don't know in this case whether surgeons explained well. Just have Medicare data showing that the women had breast cancer surgery, most with lymph node dissection. But 30 to 40 percent died w/in a year anyway and most had functional decline. Is that good medicine?

Good medicine is to offer everyone the accepted treatment Depression, elderly abuse, lack of resources, loss of will to live make people opt for no treatment sometimes A physician treats a human For policymakers they are statistics to calculate cost benefit MDs can’t do that

Understood. Here, the woman had capacity and declined treatment despite a physician's pressure. Her family supported her. She had no symptoms from her breast cancer, died of another cause two years later. Why isn't that a perfectly reasonable decision?

I agree I mentioned older person are under family pressure to do their bidding, you know how children pressurize their parents with fear etc. if a person makes a conscious decision based on all available choices understanding that treatment offered could help & declines that’s ok

I didn't read the article, but having just gone through biopsy then lumpectomy, just leave her alone. It all amounts to torture and she shouldn't be subjected to such barbarism.

Hope you are recovering well.

Because if it's a tumor he thinks surgery, chemo and radiation would be a good idea?

Yes, he probably would think so. Why recommend a biopsy if not to guide future treatment? But as this study shows, mortality rate for these women (because they're frail and ill, not because of age) after surgery is very high and most decline in function. He may well be wrong.