Leah Bracknell, started raising funds ~3 years ago for alternative cures of her stage 4 lung cancer. Bracknell who, after her acting career, had become a yoga teacher said at the time that, in the UK, she was given “a fairly brutal and bleak diagnosis, but one I am determined to challenge”. Her partner, Jez Hughes, who helped with the fund-raising said the money would be used for “immunotherapy and integrative medicine, which are seeing previously ‘incurable’ cancers going into complete remission”.
The team thus raised over £50 000 and went to Germany, a country that is well-known for its liberal stance on quackery. In Britain, there are just a few physicians who are devoted to this or that alternative medicine. In Germany, there are thousands of them. In addition, Germany has a healthcare profession called the ‘Heilpraktiker’, a poorly-regulated left-over from the Third Reich. A Heilpraktiker has not studied medicine, yet is legally permitted to make all sorts of unsubstantiated claims and treat many serious diseases, including cancer, with unproven therapies.
It was reported that Leah Bracknell went to the ‘Hallwang Private Oncology Clinic’, an institution which claims that “Healing-oriented and individualised medicine considers all aspects of lifestyle and not only relies on conventional treatments and recent cutting-edge developments in medicine, but also takes into account our experience in natural remedies and is open for alternative treatment options in order to work in synergy with conventional treatment strategies. We always try to be as natural as possible and as conventional as needed to achieve the best results. Integrative Health Concepts are successfully used in many diseases including malignant diseases, neurological disorders as well as in prevention and rehabilitation.” The SCAMs used there include homeopathy, micronutrients, natural supplements, whole body hyperthermia and ozone therapy.
The evidence does not support these or other alternative cancer ‘cures’. In fact, the very notion of an alternative cancer cure is nonsensical: if an alternative cancer therapy showed even the slightest shimmer of promise, it would get investigated and, if shown to work, become part of routine oncology. The suggestion that there are treatments out there that are effective, yet shunned by oncologists because they originate from nature or from some exotic tradition is insulting and utterly barmy.
Yet cancer patients can easily fall for such claims. They are understandably desperate and listen to anyone promissing a cure. Therefore, they all too easily believe in weird conspiracy theories of ‘Big Parma’, the evil ‘establishment’ etc. who allegedly suppress the news of an effective therapy, as it might threaten their profits. If they do fall for such lies, they not only lose pots of money but also their lives.
Last Wednesday, it was reported that Leah Bracknell had died of cancer.
29 Responses to Leah Bracknell (1964-2019): another victim of cancer quackery?
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Probably not the best case for death by alternative medicine. Better than 3 years survival with stage 4 lung cancer is not an unusual result even with the best conventional therapy. At most it demonstrates someone spending a lot of money for no improvement in an expected result. Outrageous yes but not on the level of death due to a more treatable disease.
I find it very discouraging trying to talk with people who have been sold on SCAM treatments. No matter what you say you are the one who is ignorant and closed minded. There is a cultural misunderstanding of what science is and how it works. It is easy to create a strong distrust of evidenced based medicine when we live in a society so full of scams. Being able to parse information sources seems beyond the skills of many people.
“it demonstrates someone spending a lot of money for no improvement in an expected result”
that’s why I entitled the blog VICTIM OF and not DEATH DUE plus put a ‘?’
Prof Ernst – you and your fellow critics of CAM, I think have gone too far :in your mission to discredit and call quackery on CAM, you think it acceptable to comment on Leah’s life choices.
Unless any of you CAM sceptics knew first hand her medical situation, you are not entitled to assume or expound your views on her medical journey.
If you are concerned about the thousands raised to aid her recovery, speak to those who donated: maybe you will be reassured there are no regrets and would do the same again.
If Leah and her family made decisions to follow a path you disagree with, then speak to the family : they may say it was all worth it.
Dr Julian comments that immunotherapy on the NHS would have been a better option. How do you know this option wasn’t removed?
Interestingly, I just read an article by a doctor who writes a weekly column in a broadsheet. ‘Back in the noughties a BMJ senior editor – a doctor – had cancer warranting surgery and treatment. Three years ago the cancer recurred. Her surgeon suggested several treatment options, and would write to let her know. Several weeks later she heard from a junior doctor that she had been discussed at a MTD meeting where decisions were made re chemo, surgery’ This is not the article verbatim just the gist. This doctor, the article says, did her own research and made her decisions, but was infuriated that a group of doctors she had not met had made the decisions. She discovered this was the norm since her last cancer. The doctor maintains that ‘ patients should insist there should be no decision about me, without me’ and should rest not with some shadowy team but the consultant in charge.
It is an interesting take and maybe a reflection on an overburdened NHS . As I have commented before, I have the utmost respect for so many of the medical professionals.
The cogent point i return to is you all seem to think you know what is best for everyone who follows a different path, without reflection that we came with our own decision making ability and alongside our loved ones , we do our best. Maybe Leah’s family have comfort in knowing they did.
RIP Leah. I won’t respond to anything in this thread : one that was inappropriate in the first place that led me to this comment. We are not quite at the stage of losing free choice.
So you think it is OK when desperate people are lied to to that they can be cured of their cancer, but that it will cost them all the money they have – and often far more, to be begged from their friends, family and even strangers?
Because none of all those expensive treatments have actually proven to work. NOT ONE. And the people who offer these treatments are invariably quacks and liars.
And you think that this kind of despicable, horrible fraud is not only acceptable, but should be tolerated?
No, of course there is nothing wrong with the choices that Leah Bracknell made. She was preyed upon by professional scammers who take advantage of the desperation of terminally ill people.
But yes, choices like she made should be made impossible – not by denigrating cancer patients who will of course try anything that they are told can cure them, but by treating these horrible quacks for what they are: frauds, liars and scammers. Places like the Hallwang clinic should be forcibly shut down, not tolerated, and its quacks should be punished instead of payed.
Well said! The truth is those who believe everything alternative medicine says believe in a just world hypothesis the cannot and will not accept the truth add hi status and a lifetime Persuit of bogus beliefs and a person will do anything to confirm their delusions..
Well put Angela
@ Angela on Saturday 19 October 2019 at 10:43
“you think it acceptable to comment on Leah’s life choices”
Once again, you have it wrong. It was not a “life choice”, more a death wish, even inadvertently. She has two children who should be rightly aggrieved by loons who lead their mother away from real medicine.
Your ignorance knows no bounds.
Ernie…you seem to live in an alternative universe! Since when are CAM treatments for cancer more expensive than conventional oncology except in extremely rare and idiosyncratic instances that only YOU could cherry-pick.
But you would rather insinuate a problem rather than provide real evidence of one. It is more than a tad ironic that you choose to use individual case reports when it suits your needs (or when you can stretch the truth in order to fit your narrative) and to then attack individual case reports of successes with CAM treatment. No irony here!
1) Thanks for addressing me ‘Ernie’ and thus showing your mental age.
2) “you seem to live in an alternative universe!” yes, I do live in the universe of adult scientists; it seems alien to you, I know.
3) “Since when are CAM treatments for cancer more expensive than conventional oncology” read it again and verify that I did not make such a claim.
4) for risk assessments, case reports are often useful.
Remind us, Dana, of what happened to those two giants of homeopathy, “experts” both, Tinus Smits and Kaviraj, when they treated their cancers homeopathically.
Lenny…
Ohhh my gosh. And allopaths never die from cancer…they live on forever and only die from accidents such as believing their own bullshit.
Dana
Your pathetic attempts at argument are sometimes quite breathtaking in their self-delusional stupidity. Put your straw men away and show us some decent evidence that homeopathy can cure cancer. You can’t. And you know you can’t. So you deflect, yammer and stamp like the petulant child you are. You are worthy only of utter contempt you foolish little man.
but otherwise, he is ok.
@Dana
Mind of I call you Bert henceforth? You know, the dim one, who always ends up at the butt of the joke, frustrated because no-one takes him seriously.
This is a rather ironic allegation, as I’ve always thought that it was SCAM adherents who live in an alternative(!) universe – a universe of their own making, no less, governed by some rather peculiar laws:
– Less is more and vice versa.
– Anything you make up is real until proven otherwise (usually referred to by SCAMmers as ‘facts’).
– Personal, singular experiences are the best and most reliable source of knowledge and information.
– The huge body of peer-reviewed scientific research on the other hand can be dismissed out of hand (except, of course, in those rare cases where it serves to confirm the previous law).
– All things ‘natural’ are by definition Good – with the exception of those natural things that are taken up by regular pharmaceutical companies. These things then no longer classify as ‘natural’ but instead as ‘chemical’ and ‘toxic’, and have therefore become Bad.
– Totally unproven alternative treatments may be sold to even the most desperately ill people under the pretence of ‘potential cure’, whereas proven effective regular treatments are dismissed as ‘Cut, Poison and Burn’, ‘merely treating symptoms’, and so on.
– Prevention of disease is touted as one of the best things one can do – except of course for what is arguably the most effective way of disease prevention: vaccination. In the Alternative Universe, mass vaccination is perhaps the most Evil thing devised by medical science, on par with genocidal atrocities known from history.
Interestingly enough, there appears to be one thing exempt from the laws of this Alternative Universe: money. No matter how homeopaths and other SCAMmers preach that less is more, and that the most potent medicines are those without any active substance whatsoever, and that everything should be done in a Natural way, they will only accept real, hard cash. And the interesting thing is that just like in real medicine, they will often charge more if the condition is more serious.
Sorry
Bert, erm, Dana, but looking at just the costs of a treatment says nothing at all. One also has to take the effectiveness into account, and of course which party is paying.Some examples from the Netherlands:
Lung cancer has treatment costs of some €25,000 per case (€ 401 million total annual costs for a total number of some 17,000 patients, with 13,300 new cases per year).
Treatment costs of breast cancer are some € 6300 per case (€ 850 million annually with a prevalence of 135,000 cases), see https://www.volksgezondheidenzorg.info/onderwerp/borstkanker..
Treatment of cervical cancer, OTOH costs our society some € 100,000 per case, making it one of the more expensive types of cancer (maybe because treatment can be rather complicated, but this is just speculation on my behalf).
These costs are almost fully covered by our system of health insurance; patients have to contribute € 350 per year maximum.
Treatment success varies strongly, depending on the type of cancer, e.g. childhood leukaemia has a cure rate of 80+% when treated conventionally, whereas pancreatic cancer is almost always fatal within a few years. Generally speaking, treatments have significantly improved over the decades, such that 50 years ago, less than 40% of cancer patients survived 5 years post-diagnosis, whereas this number is now over 60% IIRC.
Summarized: with regular medical treatment, many cancer patients have a reasonable chance to survive or at least significantly prolong their life, with only a small personal financial burden.
Now let’s go take a look in the Alternative Universe.
Costs charged by SCAMmers in a clinical setting are comparable to those of regular treatments – I find amounts between $ 10,000 and $ 150,000, so not much of a difference there.
But
– NOT ONE of the SCAM treatments offered has proven efficacy, and many of those treatments isn’t even remotely plausible.
– As these treatments are usually not covered by any health insurance, patients usually have to pay for them out of their own pockets, often ending up losing every last penny they have, selling their valuables, mortgaging the house, and begging with friends, family and strangers (crowd funding) for more, so that they can give it to the SCAMmers.
Ah, you ask why health insurance doesn’t cover these costs? well, just see the previous point, combined with the fact that in your Alternative Universe, there doesn’t appear to be something called ‘insurance’, or any other way to make sure that everyone has equal access to what you call healthcare (and everyone else calls quackery).
So,
Bert, erm, Dana, instead of complaining about healthcare in our science-based universe, why not make your Alternative Universe a better place, and think of ways that desperately sick people are NOT stripped of every last penny for treatments that have no proven efficacy?NOTE: if so desired, I can also provide links to support the figures I mentioned, but as this answer is already long read as it is, I just gave a few links by way of example.
I am a little surprised at some of those figures, particularly for cervical cancer.
I can understand breast cancer being relatively cheap. Most cases will be localised at the time of diagnosis and will have curative treatment consisting of surgery, with or without radiotherapy (using a straightforward technique and a relatively small number of fractions) plus or minus chemotherapy (using long-established drugs which are off-patent and therefore cheap) plus or minus hormonal therapy (continued for five or ten years, but again using fairly low-cost drugs). The minority of cases which recur or are advanced at diagnosis are also mainly treated with relatively low-cost drugs.
Lung cancer is a bit more complicated. If the tumour is localised the surgery is clearly much more major, and if the patient is unsuitable for surgery the radiotherapy is more complex. For advanced cases (most of them) some new drugs have become available comparatively recently which make quite a marked difference to life expectancy and quality of life, particularly immunotherapy. These drugs are very expensive (about £5,000 per month each in the UK) and will continue to be so until their patent runs out.
I don’t understand, however, why cervical cancer should be so expensive, unless all the costs of screening are included. Most cases have a long pre-cancerous phase (about a decade) allowing several opportunities to pick them up with screening, in which case preventative treatment (such as cone biopsy) is very effective. Unfortunately there is a much more aggressive form, particularly affecting young women, which is becoming more complicated. If invasive cancer is diagnosed, it is generally treated by hysterectomy alone. For more advanced (but still localised) cancer the treatment is radiotherapy combined with chemotherapy to increase the sensitivity to radiation. Again the drugs used are relatively cheap, and although the radiotherapy is relatively complex (including temporary implantation of radioactive sources) it is still much cheaper than, say, prostate cancer radiotherapy, which requires a lot more fractions. If the cancer has spread at the time of diagnosis then there are some targeted drugs available, again expensive, but this is a minority of cases and I wouldn’t have thought it would affect the average cost per case to that degree.
Screening has halved the deaths from cervical cancer in the UK, but of course now that the HPV vaccine is available it is almost completely preventable.
Of course if a young woman with a family dies of the aggressive form of cervical cancer there are significant social costs, but I would be surprised if those figure in the numbers you are quoting.
Until comparatively recently lung cancer tended to be diagnosed late and treatment wasn’t very effective (or expensive), so most people died fairly quickly at little cost. Indeed cigarette smoking used to provide quite a good revenue to the Government from taxes, as most of the diseases that it causes strike at around retirement age and kill you fairly quickly, therefore not requiring expensive health care or pension payments. Now, of course, we have legislation which discourages people from smoking and also it is less acceptable socially than it used to be, though as it takes 30 – 40 years to make you ill there is still a large cohort of smokers and ex-smokers in the pipeline.
@Dr Julian Money-Kyrle
Yes, good of you to notice, I was already a little surprised too about the cost of cervical cancer, and I found my mistake: I only counted the incidence (some 700 cases annually), not prevalence (5,400 cases at any given time).
For all completeness, this is my source with the cost figures, amounting to total annual costs of € 117 million (2015 figures).
‘Beheer’ translates as ‘Administration’, although I’m not completely certain what that item covers and what not.
‘Openbare zorg en preventie’ (€ 35 million) comprises prevention, i.e. screening and HPV vaccination – I subtracted this figure from the total because I’m primarily interested in treatment cost.
‘Ziekenhuiszorg’ is hospital care, some € 30 million, and ‘Eerstelijnszorg’ (€ 15 million) comprises primary healthcare (GP, in-home care etc.).
So if I take the € 117 million, deduct the € 35 million for prevention, and base the calculation on prevalence, I reach an annual treatment cost of € 15,000 per case. Still, from the prevalence/incidence ratio, I’d estimate that the total cost of each case of cervical cancer over the years is about 7 times this figure, so that makes € 100,000 again … (and in fact this would suggest that the total treatment costs for other types of cancer should be adjusted accordingly before comparison with SCAM treatment costs).
So thanks again – and correcting each other is the way to go!
Richard,
That sounds even stranger. My experience of cervical cancer is that most people are cured and the rest die pretty quickly, so I would not expect the prevalence to be very different from the incidence. I have just checked with the Cancer Research UK Web site, which gives fairly detailed statistics for most of the major cancer types, and their figures would support that (ten-year survival about 63%, and from the survival curves nearly all the deaths are within the first two youears with most of them being in the first year). So I don’t know what your prevalence statistic actually refers to here. Perhaps it includes people who have been treated but not yet discharged from follow-up (which would probably be about right if the follow-up period is nominally ten years). Follow-up might consist of a 6-monthly clinical examination and an annual smear from the vaginal vault, which is clearly going to be a lot cheaper than the surgery / radiotherapy etc. required during the first year. On the other hand, there will be costs associated with managing the sequelae of treatment, such as sexual problems associated with a shortened or stenosed (narrowed from scarring) vagina, effects on self-image etc. as well as the small number of people who might have more serious long-term problems such as radiation enteropathy (there was a cohort of women treated in Manchester 40 or so years ago before the radiobiology was understood with regard to dose rate and how different tissues are affected differently by changes in the way the dose is given, and many of them had very distressing – and expensive – long-term problems).
I think if you are trying to calculate cost-per-case from annual expenditure, the incidence is probably a better figure to use than prevalence as most of the expense will be in the first year, and in any case the amount spent on cases from previous years will be balanced by the cost of managing this year’s cases in the subsequent years. This, of course, assumes that the incidence, the survival rates and treatment costs are reasonably stable. This is certainly not the case for lung cancer, but treatment of cervical cancer has changed less (apart from the more recent use of expensive targeted therapies in women with advanced disease at the time of diagnosis).
Cost-per-case figures are essential when commissioning health care services, so they certainly exist somewhere, though I am afraid I can’t tell you where to look for them. Although they are sometimes calculated rather strangely – for instance there was a time when our budget-holders had a fixed price that they would pay our centre for a patient undergoing radiotherapy, regardless of whether is was a single fraction using a simple set-up to palliate bone pain or a complex technique involving daily treatment for seven weeks or more, for instance for radical treatment of prostate cancer.
@Dr Julian Money-Kyrle
Even though this is about rather sad statistics, I find this hugely interesting, also from my work perspective(*) – it just goes to show that even with quite accurate official figures, it isn’t all that straightforward to calculate something like cost-per-case.
For all completeness, this is where I obtained the incidence and prevalence figures, and yes, the prevalence is calculated on a ten-year basis, as you already presumed.
Now all this may seem off-topic, but if it is already this tricky to say something definite about things like costs and success rates with good statistics on real medicine, how can we ever trust claims from SCAM practitioners and clinics, whose record-keeping is quite poor, if not completely absent?
*: As you no doubt already gathered, I’m not a doctor, although I’m tangentially involved in medicine with my business in (among other things) biomedical electronics. I sometimes need to do some preliminary (desk) research before a customer decides to spend money on a new development, and almost every time, it turns out to be pretty challenging to get even the simplest numbers straight.
No. There are people whose full-time jobs are to do this.
And then there are individuals who can skew the data. Somebody whose cancer follows an unusually slow natural history and who responds well to treatment can end up living a long time and having one expensive drug after another over a period of many years, costing a total of hundreds of thousands of pounds. This is one reason why we use median survival figures and not mean survival in cancer research, but when calculating cost per case you have to use the mean and not the median, otherwise you end up not allocating enough funds.
Oncology departments used to spend most of their drugs budget on ondansetron (the first really effective antiemetic, which transformed how chemotherapy could be given). Now, these costs are dwarfed by the new targeted and biological therapies, even though they are only beginning to come into clinical use, with many more ithe pipeline.
According to the UK Cancer Research website the 1 year median survival rate from diagnosis for stage 4 lung Cancer is 20%. This is based on data from before 2014. However the site also states that overall survial rates for lung Cancer had not improved much in 40 years so it is unlikely that the prognosis for lung Cancer has changed much over the last 3 years. As she survived for 3 years from diagnosis I would conclude that the evidence would suggest that she got lucky and that it is unlikely that she was a ‘victim of’ any treatment given.
and what about the £50 000?
I would concur. I wonder what the average “traditional” care for stage 4 Lung Cancer would cost for those 3 years???
You would concur that the survival rates for lung cancer have not changed in 40 years? What is that based on? Are you familiar with recent developments such as stereotactic radiotherapy, thoracoscopic surgery and the impact of immunotherapy, and the large volume of published research demonstrating the impact that they are having?
Traditional care for stage 4 lung cancer in the UK involves the use of such drugs as pembrolizumab which cost about £5,000 per month plus hospital costs and the cost of community and palliative care, though it is unlikely that anybody would be receiving the same high-cost drug continuously over a three-year period. This cost is borne by the National Health Service and therefore ultimately by taxpayers; although the NHS normally makes a nominal charge for out-patient prescription drugs (which does not reflect the true cost of the drugs), cancer patients are exempt from this, so their treatment is essentially free.
I know the system is different in other parts of the world, particularly the US, where healthcare is seriously dysfunctional.
She clearly was lucky to have survived for three years with stage 4 lung cancer, but as you say, that is by no means unheard of. The median survival figures also include the many people who die within weeks of diagnosis, often before they have the chance to start treatment (or are already too unwell for it when they are diagnosed), so if she was well enough to travel to Germany for treatment she was already in a better prognosis group.
However, she would have been better off staying in the UK and having immunotherapy here (at least the cost of her treatment would have been borne by the NHS). Current treatment of stage 4 non-small cell lung cancer involves a combination of chemotherapy and immunotherapy, which doubles the overall survival. Here is an update to a trial of pembrolizumab in combination with pemetrexed and platinum:
https://ascopubs.org/doi/abs/10.1200/JCO.2019.37.15_suppl.9013
It could be argued that in this case 9 months was a probable outcome. Have the relatives complained? Do they attribute the longer than expected survival time to any treatments? If so then they may consider it 50K well spent. Whatever the reason she lived for 3 years which is longer than expected and this isn’t the best example for you to make your point.
To make your point you may need to find a case of someone who rejected conventional treatment for a Cancer with a much higher % success rate and then died after 3 years or less. ie Leukemia. Then questions may be asked by the relatives about the 50K. Then you have a blog post worth sharing.
Quacks are bad, but cancer quacks are probably the worst and most revolting SCAMmers out there, selling desperate people false hope, often robbing them not just of all their savings, but also of their last months in life — time that could have been spent far better with friends and family, trying to reconcile one with one’s fate, than pursuing all sorts of totally useless treatments in the vain hope for recovery.
At least avian vultures have the decency to wait until their victims are dead before stripping them to the bone.
And one must consider: what was her quality of life during those 4 years? What would it have been for four years with CON-MED chemo-torture with an assurity of death anyway? That $50,000 pounds might have been very well spent.
No. Cancer patients who turn to quacks tend to die sooner and suffer more.
Source: https://edzardernst.com/2013/04/cancer-patients-who-use-alternative-medicine-die-sooner/
And I would even go as far as to say that the more expensive a ‘treatment’ is, the more patients will suffer — because naturally, you can’t get away with charging $50,000 for a few drops of shaken water or some useless sugar crumbs. As a cancer SCAM artist, you will make sure that patients gets what they paid for: extensive, radical, hard-to-follow(*) treatments, served up with generous helpings of false hope(**), and above all lots and lots of personal attention (which is another very safe way to further crank up an already astronomical bill).
*: Which provides the SCAMmer with a handy excuses when it becomes clear that the ‘treatment’ inevitably fails to deliver the promised result, and people realize that they will not get better after all: “Yes, but you didn’t strictly follow the regimen of four coffee enemas, twenty kale-and-carrot smoothies and two hours of hydrotherapy per day, so …”
**: And hitching a free ride on the results of preceding conventional treatment, at that: “The tumour is shrinking! Success!” — whereas this is usually the result of regular treatment some months earlier. And of course will take a turn for the worse again in some months or ultimately years to come, because those SCAM treatments do nothing at all except drain patients physically, emotionally and financially.
Why do you insist on defending some the most despicable humans around?
About the quality of life with regular treatment: palliative care has become very good in the past decades, and oncology in particular is very careful to discuss the various treatment options with patients. E.g. terminal patients will not get offered heavy chemotherapy, and they most certainly will not be deceived by keeping hope for a cure alive. Yes, palliative care involves pain medicine, plenty of it — and if you dare tell us that this is a bad thing, you are just as despicable as the aforementioned quacks.
The main thing that affects quality of life in cancer patients is the cancer itself. It is unusual for the effects of chemotherapy to be as bad as the effects of an uncontrolled cancer.
In any case, prior to each dose of chemotherapy there is a clinical review to assess whether the patient is responding, whether there are any factors (such as infection) that might necessitate a delay in treatment and most importantly what side-effects they are experiencing. If there are significant side-effects then the management needs to be changed, either by adjusting the treatment regimen or if necessary by stopping the chemotherapy altogether. Serious side-effects might be acceptible where the aim of treatment is to cure the patient (e.g. acute leukaemia), but in this situation the whole point of chemotherapy is to improve the patient’s well-being, not to destroy it.
It is also worth considering that the data suggest that with current state-of-the art treatment she may have had the chance of living 8 years not 4 (that is an extrapolation as the Keynote studies are too recent to have 8-year follow-up data, although the doubling in median survival does not seem to depend on whether the disease is aggressive or not).
My advice to anybody making an informed decision not to have chemotherapy in this situation would be to spend the $50,000 on holidays with their family.