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Who Survives Cancer?

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FACT OR FICTION?

*A white male earning over $35,000 a year has a better chance of surviving most types of cancer than an unemployed African-American male.

*Psychological factors predispose people to contracting cancer and improved emotional health promotes recovery.

*Early detection is useless in curing cancer.

*Experimental, not conventional, treatments offer the most benefits and longer survival rates to cancer patients.

*A scientific breakthrough of practical and immediate significance in cancer treatment is ...

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Overview

FACT OR FICTION?

*A white male earning over $35,000 a year has a better chance of surviving most types of cancer than an unemployed African-American male.

*Psychological factors predispose people to contracting cancer and improved emotional health promotes recovery.

*Early detection is useless in curing cancer.

*Experimental, not conventional, treatments offer the most benefits and longer survival rates to cancer patients.

*A scientific breakthrough of practical and immediate significance in cancer treatment is imminent.

*Cancer prevention is ineffective in many areas and campaigns will probably never achieve a reduction of cancer mortality approaching 50 percent.

*Health Maintenance Organizations (HMOs) increase survival chances for most cancer patients.

Howard Greenwald takes an incisive new look at how class, race, sex, psychological state, type of health care and available treatments affect one's chance of surviving cancer. Drawing on an original ten-year survival study of cancer patients, he synthesizes medical, epidemiological, and psychosocial research in a uniquely interdisciplinary and eye-opening approach to the question of who survives cancer and why.

Scientists, health care professionals, philanthropists, government agencies, and ordinary people all agree that significant resources must be allocated to fight this dreaded disease. But what is the most effective way to do it? Greenwald argues that our priorities have been misplaced and calls for a fundamental rethinking of the way the American medical establishment deals with the disease. He asserts that the emphasis on prevention and experimental therapy has only limited value, whereas the availability of conventional medical care is very important in influencing cancer survival. Class and race become strikingly significant in predicting who has access to health care and can therefore obtain medical treatment in a timely, effective manner. Greenwald counters the popular notion that personality and psychological factors strongly affect survival, and he underscores the importance of early detection. His research shows that Health Maintenance Organizations, while sometimes prone to delays, offer low-income patients a better chance of ultimate survival. Greenwald pleads for immediate attention to the inadequacies and inequalities in our health care delivery system that deter patients from seeking regular medical care.


Instead of focusing on research and the hope for a breakthrough cure, Greenwald urges renewed emphasis on ensuring available health care to all Americans.
In its challenge to the thrust of much biomedical research and its critique of contemporary American health care, as well as in its fresh and often counterintuitive look at cancer survival, Who Survives Cancer? is invaluable for policymakers, health care professionals, and anyone who has survived or been touched by cancer.

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Editorial Reviews

Publishers Weekly - Publisher's Weekly
Addressed more to health-care professionals and policymakers than to the lay public, this book by Greenwald ( Social Problems in Cancer Control ), a professor in the University of California's School of Public Administration, makes it clear that we are not winning the war against cancer. In a well-documented text, he looks at how class, race, sex, psychological state and available treatments can affect one's chances of survival. Much of the book focuses on the Seattle Longitudinal Assessment of Cancer Survival, whose researchers have collected data of patients with diagnoses of four cancers--lung, pancreatic, prostate and cervical. Greenwald claims that preventive and experimental therapy have limited value, and that conventional medical care is crucial in influencing cancer survival. He underscores the need for early detection, but is quick to note some of its limitations, especially in certain kinds of cancer (e.g., pancreatic). Instead of concentrating on research and the hope of a breakthrough, he believes the goal should be extending access to basic care for all Americans. People can increase their chances of surviving, he believes, by getting practical--learning more about therapeutic options and obtaining second opinions. (Oct.)
Library Journal
Epidemiological studies reveal surprises about the likelihood of surviving cancer, according to this important book. The author's original research on cancer mortality indicates that timely access to health care--readily available to affluent white Americans but not to impoverished minorities--is one of the most important factors in cancer survival. Greenwald's findings also cast doubt on many psychosocial theories of cancer survivorship. He contends that more health-care dollars ought to be allocated to making conventional health care available to all races and classes rather than to experimental treatments and preventive approaches. Thought-provoking and highly recommended for research collections.--Judith Eannarino, Washington, D.C.
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Product Details

  • ISBN-13: 9780520077256
  • Publisher: University of California Press
  • Publication date: 10/23/1992
  • Edition number: 1
  • Pages: 280
  • Product dimensions: 6.30 (w) x 9.34 (h) x 1.13 (d)

Meet the Author

Howard P. Greenwald is Professor in the School of Public Administration at the University of Southern California and the author of Social Problems in Cancer Control (1980).

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Table of Contents

List of Figures
List of Tables
Preface
1 The Problem and Its Context 1
A Disease of Our Times 6
The Availability of Care 9
Personal Choice and Avoidable Mortality 17
2 The Disease and Its Survivors 22
Cancer: A Complex Phenomenon 23
The "Cure" for Cancer: Defining an Elusive Goal 30
Beyond Science: The Quality of Life 35
3 Cancer Treatment: The Industry of Hope 38
The Practice of Conventional Care 40
Experimental Therapy 51
Alternative Cures 58
The World of Cancer Science 62
4 Can Cancer Be Prevented? 66
Exogenous Causes of Cancer: Opportunities for Prevention 67
Endogenous Causes of Cancer 84
The Limits of Cancer Prevention 88
Postscript on Prevention: Heart Disease and Cancer 91
5 Emotional Health and Cancer Survival 94
The Emotional Theory of Survival 96
Culture and the Psychology of Survival 97
Psychotherapy for Cancer 100
What Do the Studies Really Say? 102
Debunking the Myth: New Research Findings 109
6 Early Detection: The Key to Cancer Survival? 119
The Case for Early Detection 120
The Limits of Early Detection 125
Early Detection and Survival in Three Cancers 134
Are the Survival Advantages Real? 142
7 Class and Cancer Survival 147
Class and Health Care 148
Definitions of Class 153
Social Class and Mortality Risk 155
Social Factors and Cancer Survival in the United States 159
Income, Education, and Survival: The SLACS Findings 163
8 The Health Maintenance Organization: A Model for the Future? 173
The Rise of the HMO 174
Quality of Care in the HMO 180
Group Health Cooperative: A Landmark HMO 184
Cancer Treatment and Survival in the HMO and Fee-for-Service 186
The HMO: A Sign of Progress? 190
9 Conclusion: Personal Strategies and Public Issues 193
Individual Survival Strategies: A Consumer Perspective 195
Public Decisions and Cancer Survival 201
Appendix A: The Seattle Longitudinal Assessment of Cancer Survival (SLACS) 209
Appendix B: Statistical Methods and Tables 214
Notes 257
Index 273
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