As the price of chemotherapy now routinely reaches $100,000 for a full treatment course, my patients are forced more and more into making the equivalent of Sophie's Choice when it comes to treating their cancer: Spend down their savings for an improvement in survival that might amount to a few weeks, secretly hoping that they will be one of the lucky few at the "tail" of the survival curve – the handful of people who live years more; or decline the therapy and in so doing ensure that their families will be provided for after they have died.