As one of the main characters lives in the United States and develops incurable inoperable cancer, she receives several courses of treatment all of which have to be funded by and adequate health insurance plan, and so therefore in large part by the patients family, depleting their life savings. Most reviews of the book therefore focus on criticism of the American Healthcare system, but as an oncologist I saw it as a fascinating insight into the dilemmas of cancer patients and their families when they are undergoing palliative chemotherapy, whether it be with traditional or novel treatments.
In the United States, the cost of these treatments is borne by patients, usually via medical insurance policies, whilst in the United Kingdom it will be taken on by the NHS provided the drugs were NICE approved and would only be paid for by individuals if they were not.
Reader of Shriver's novel witness a patient going through ultimately futile treatment with significant toxicity, whilst her hopes are inappropriately raised by her oncologist and her colluding family and friends, at least initially however after the cancer and chemotherapy have taken an increasing toll, her husband asked the doctor how must he estimates the treatment has cost. "About two and a half million," replies the oncologist. "What do we get for that," enquires the husband. "I think it gave her a good 3 months extra," says the doctor. "It may have been extra," says the husband, "but none of it was good". This sentiment rings true. Patients expectations of palliative chemotherapy, and particularly the much publicised new drugs, are inappropriately raised by their own hopes, the media, and sadly often by their treating physician.
We do not always detail the precise benefits of these treatments, and indeed many cancer patients think their treatment might extend their life by a number of years whereas in reality, if successful the benefit is measured in terms of weeks or months. This book is a useful and salutary reminder of just what cancer treatments really `cost'.