"Because the reimbursement system, in this case Medicare, continues to say 'yes' to more disease treatment, there is no pressure from the reimbursement process to have patients, families, or their physicians say, 'Wait a minute. This is not in the patient's best interest.' "
He also believes that healthcare providers, patients and their families are conflating "two different concepts… disease treatment and patient care.
"We doctors want our patients to live as long and well as possible. But there is some confusion about what is the best treatment for the disease is, and what is the best care for a person living with cancer is.
"I don't think there's ill intention… but in trying to give the very best attention to patients and families, there is the [tendency] to put more and more intensive and aggressive disease treatment in place when what people really need is the best care."
"At some point in time, as incurable cancer progresses, more treatment does not equal better care," Byock said.
Byock elaborated on generally accepted guidelines and endorsed measures for cancer care. For example, he says, for a patient with advanced non small cell lung cancer, after the third round of chemotherapy if the cancer continues to progress, "further cytotoxic chemotherapy is not in the patient's best interest, and outside of a formal clinical trial it should not be given.