what happens after being 5-years NED?

Question

NED - as in No Evidence of Disease..
When someone gets to the 5-year mark, they are considered Cancer Free. But do they continue to get scans, and tests? Or does insurance no longer cover it? Some people would want to continue to get checked out? What happens..

Answer 1

There really isn't any 'magic number' of years and than you're 'cured'. There are over 200 different types of cancer and all have different 'stages' and grades of tumor. So for someone who had a Stage 1, small tumor thats been totally surgically removed . . the further they get from that treatment the more likely the cancer is 'cured'. However, if a patient has a Stage IV aggressive cancer . . . and is in remission . . it might be a good idea to keep checking for an undetermined amount of years. Microscopic metastatic cells have the ability to lay dormant for an undetermined amount of time and than start regrowing again. So, it is possible with some types of cancer and some grades of cancer that a person will need to stay vigilant indefinitely.

As you can imagine, the insurance companies do not like the idea at all. Many cancer patients end up fighting insurance denials for 'well' CT . . since they consider them now to be 'medically unnecessary'.

I believe though that the rule of thumb (the one I've heard) is that the longer a person is in remission the more unlikely that the cancer will return. And for the majority of patients with Stage I and Stage II disease the five year mark may be fine to let up a bit on the thoughts of reoccurence. Stage III and Stage IV may need to watch for quite a few more years. There is no guarantee.

Answer 2

You bring up an interesting point.

The five-year marker was originally an invention of the American Cancer Society, but has since been adopted by statisticians as an arbitrary indication of being cured.

Most patients who reach that point, start their own 5-year clock based on when they are given the "all clear" sign. But the American Cancer Society and the National Cancer Institute don't measure their statistical 5-year cure rates that way at all.

Their imaginary five-year mark is not based on "No Evidence of Disease." The clock starts running from the day the disease is diagnosed. Thus a person might die from their prostate cancer on day one after they've received their five year pin, but be considered cured of their disease, according to the American Cancer Society and the National Cancer Institute's SEER stats.

The '5-year cure' is an odd definition if one can be classified as cured, yet be the unproud owner of a growing malignant mass.

The 5-year clock was shortened at some point, by taking into consideration average life expectancy. This little statistical trick helped to create the illusion that modern medicine was getting better at 'curing' cancer, which once again makes it look like modern medicine has gotten better at treating cancer.

This had a huge altering effect on 'measuring the cure rate' because cancer becomes much more common as one gets older. If the statistician can shorten the five years to four or three years among those with the highest incidence of cancer, that sleight of hand makes it look like something positive has happened to the cure rate.

After that was done, the American Cancer Society claimed that treatments had improved from a one-in-three chance of living for five years to one-in-two. In reality, nothing had changed, except the calculation itself.

Along the way, modern medicine also got better at spotting cancer about six months sooner on average. This also has the effect of starting the five-year clock six months sooner, a great boon to fundraising for those who wanted to claim that we are winning the war on cancer.

A ten percent jump on the clock doesn't necessarily impact the survival stats by ten percent. Depending on the average survival time for a particular diagnosis, the 'improvement' could be 20 or 30 percent or even higher for that particular diagnosis.

A prime example of this is prostate cancer, which might be the top cancer diagnosis for men ever since PSA tests became popularized. Elevated PSA scores have resulted in a leap in prostate biopsies, resulting in a much higher incidence rate for prostate cancer...so much so that prostate cancer leapfrogged lung cancer as the #1 cancer for men.

This shift from a fast growing cancer to a slow one was a boon for those relying on the 5-year cure rate as their measure of whether modern medicine was winning the war on cancer.

Prostate cancer is often a very slow growing cancer. One of the methods of treating it is "watchful waiting." By increasing the gross number of men diagnosed with this slow growing disease, it creates a false impression that more people are being 'cured of cancer' (according to the artificial 5-year monkey business) when all that has really happened is that more untreated men lasted five years since their diagnosis was officially determined.

In sum, the 5-year mark was, since its inception, not a real measure for curing cancer, and has become less so with the passage of time.

To answer your question, if the doctor and the insurance company thinks a test is medically necessary, then a test is covered by insurance. Since the 5-year construct is mainly a fund raising tool rather than a true indicator of whether one is being being cured, it's not too hard to argue that a closer eye is medically necessary for anyone who has been officially diagnosed and cancer free for 5 years or longer.

Good luck and be well.

Kelley

Answer 3

After 5 years NED, it is considered that your risk of recurrance is negligible.

BUT

You are of higher than average risk of developing a new cancer, as you have shown genetic predisposition to develope cancer and many of the treatments used in your 'cure' are carcinogenic, increasing your long term risk.

In most cases, you will continue with annual check-ups, with your local Dr as a minimum or preferably with your oncologist.

Your oncologist will recommend a schedule....