Anaximperator blog

Blogging against alternative cancer treatments

The complementary medicine detective

edzard-ernstEdzard Ernst, the UK’s first professor of complementary medicine who has become alternative medicine’s public enemy number one, has recently published a new book: Healing, Hype or Harm? A Critical Analysis of Complementary or Alternative Medicine. Michael Bond interviewed Edzard Ernst for The New Scientist.

See also this article in the Mail Online, on acupuncture and a number of other alternative therapies.

12 responses to “The complementary medicine detective

  1. evenarsenicisnatural March 19, 2009 at 5:00 am

    Your point?

  2. beatis March 19, 2009 at 7:07 am

    @ Natalie,

    I’ve seen it on the BBC this week. We had one such hospital in our country, it’s now closed. Does this prove the efficacy of alternative cancer therapies??

    You should have known by now that we are not blind to wrongs in medicine or science. That’s why there have to be laws and regulations, for everyone to adhere to, alternatives included.

    I don’t see how this proves though that Mr Isaacs pills can cure cancer or that leukemia can be cured with water fasting. You seem to think that two wrongs can make one right.

  3. natalie March 26, 2009 at 8:51 pm

    @Jli.

    Hi Jli,
    I wanted to know your thoughts on the article below … and if you feel there is any validity
    The situation posed at present for me ( not personally) is chemo has been strongly suggested however the findings below to me would suggest it not to be beneficial under the relevant circumstances.

    apologies for the lengthy post…🙂
    Thank you

    The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies.
    Morgan G, Ward R, Barton M.
    Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia. gmorgan1@bigpond.net.au
    AIMS: The debate on the funding and availability of cytotoxic drugs raises questions about the contribution of curative or adjuvant cytotoxic chemotherapy to survival in adult cancer patients. MATERIALS AND METHODS: We undertook a literature search for randomised clinical trials reporting a 5-year survival benefit attributable solely to cytotoxic chemotherapy in adult malignancies. The total number of newly diagnosed cancer patients for 22 major adult malignancies was determined from cancer registry data in Australia and from the Surveillance Epidemiology and End Results data in the USA for 1998. For each malignancy, the absolute number to benefit was the product of (a) the total number of persons with that malignancy; (b) the proportion or subgroup(s) of that malignancy showing a benefit; and (c) the percentage increase in 5-year survival due solely to cytotoxic chemotherapy. The overall contribution was the sum total of the absolute numbers showing a 5-year survival benefit expressed as a percentage of the total number for the 22 malignancies. RESULTS: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA. CONCLUSION: As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.
    PMID: 15630849 [PubMed – indexed for MEDLINE]
    _________________________________________________________
    Discussion:
    AUSTRALIAN PAPER ON CHEMOTHERAPY

    An important paper has been published in the Australian journal Clinical Oncology. This meta-analysis, entitled “The Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies” set out to accurately quantify and assess the actual benefit conferred by chemotherapy in the treatment of adults with the commonest types of cancer. Although the paper has attracted some attention in Australia, the native country of the paper’s authors, it has been greeted with complete silence on this side of the world.
    ALL three of the paper’s authors ARE oncologists. Lead author Associate Professor Graeme Morgan is a radiation oncologist at Royal North Shore Hospital in Sydney; Professor Robyn Ward is a medical oncologist at University of New South Wales/St. Vincent’s Hospital. The third author, Dr. Michael Barton, is a radiation oncologist and a member of the Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Health Service, Sydney. Prof. Ward is also a member of the Therapeutic Goods Authority of the Australian Federal Department of Health and Aging, the official body that advises the Australian government on the suitability and efficacy of drugs to be listed on the national Pharmaceutical Benefits Schedule (PBS) – roughly the equivalent of the US Food and Drug Administration.
    Their meticulous study was based on an analysis of the results of all the randomized, controlled clinical trials (RCTs) performed in Australia and the US that reported a statistically significant increase in 5-year survival due to the use of chemotherapy in adult malignancies. Survival data were drawn from the Australian cancer registries and the US National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) registry spanning the period January 1990 until January 2004.
    Wherever data were uncertain, the authors deliberately erred on the side of over-estimating the benefit of chemotherapy. Even so, the study concluded that overall, chemotherapy contributes just over 2 percent to improved survival in cancer patients.
    Yet despite the mounting evidence of chemotherapy’s lack of effectiveness in prolonging survival, oncologists continue to present chemotherapy as a rational and promising approach to cancer treatment.
    “Some practitioners still remain optimistic that cytotoxic chemotherapy will significantly improve cancer survival,” the authors wrote in their introduction. “However, despite the use of new and expensive single and combination drugs to improve response rates…there has been little impact from the use of newer regimens” (Morgan 2005).
    The Australian authors continued: “…in lung cancer, the median survival has increased by only 2 months [during the past 20 years, ed.] and an overall survival benefit of less than 5 percent has been achieved in the adjuvant treatment of breast, colon and head and neck cancers.”
    The results of the study are summarized in two tables, reproduced below. Table 1 shows the results for Australian patients; Table 2 shows the results for US patients. The authors point out that the similarity of the figures for Australia and the US make it very likely that the recorded benefit of 2.5 percent or less would be mirrored in other developed countries also.

    Basically, the authors found that the contribution of chemotherapy to 5-year survival in adults was 2.3 percent in Australia, and 2.1 percent in the USA. They emphasize that, for reasons explained in detail in the study, these figures “should be regarded as the upper limit of effectiveness” (i.e., they are an optimistic rather than a pessimistic estimate).

    Understanding Relative Risk

    How is it possible that patients are routinely offered chemotherapy when the benefits to be gained by such an approach are generally so small? In their discussion, the authors address this crucial question and cite the tendency on the part of the medical profession to present the benefits of chemotherapy in statistical terms that, while technically accurate, are seldom clearly understood by patients.
    For example, oncologists frequently express the benefits of chemotherapy in terms of what is called “relative risk” rather than giving a straight assessment of the likely impact on overall survival. Relative risk is a statistical means of expressing the benefit of receiving a medical intervention in a way that, while technically accurate, has the effect of making the intervention look considerably more beneficial than it truly is. If receiving a treatment causes a patient’s risk to drop from 4 percent to 2 percent, this can be expressed as a decrease in relative risk of 50 percent. On face value that sounds good. But another, equally valid way of expressing this is to say that it offers a 2 percent reduction in absolute risk, which is less likely to convince patients to take the treatment.
    It is not only patients who are misled by the overuse of relative risk in reporting the results of medical interventions. Several studies have shown that physicians are also frequently beguiled by this kind of statistical sleight of hand. According to one such study, published in the British Medical Journal, physicians’ views of the effectiveness of drugs, and their decision to prescribe such drugs, was significantly influenced by the way in which clinical trials of these drugs were reported. When results were expressed as a relative risk reduction, physicians believed the drugs were more effective and were strongly more inclined to prescribe than they were when the identical results were expressed as an absolute risk reduction (Bucher 1994).
    Another study, published in the Journal of Clinical Oncology, demonstrated that the way in which survival benefits are presented specifically influenced the decision of medical professionals to recommend chemotherapy. Since 80 percent of patients chose what their oncologist recommends, the way in which the oncologist perceives and conveys the benefits of treatment is of vital importance. This study showed that when physicians are given relative risk reduction figures for a chemotherapy regimen, they are more likely to recommend it to their patients than when they are given the mathematically identical information expressed as an absolute risk reduction (Chao 2003).
    The way that medical information is reported in the professional literature therefore clearly has an important influence on the treatment recommendations oncologists make. A drug that can be said, for example, to reduce cancer recurrence by 50 percent, is likely to get the attention and respect of oncologists and patients alike, even though the absolute risk may only be a small one – perhaps only 2 or 3 percent – and the reduction in absolute risk commensurately small.
    To their credit, the Australian authors of the study on the effectiveness of chemotherapy address the issue of relative versus absolute risk. They suggest that the apparent gulf between the public perception of chemotherapy’s effectiveness and its actual mediocre track record can largely be attributed to the tendency of both the media and the medical profession to express efficacy in terms of relative rather than absolute risk.
    “The minimal impact on survival in the more common cancers conflicts with the perceptions of many patients who feel they are receiving a treatment that will significantly enhance their chances of cure,” the authors wrote. “In part this represents the presentation of data as a reduction in risk rather than as an absolute survival benefit and by exaggerating the response rates by including ‘stable disease.'”
    As an example of how chemotherapy is oversold, they cite the treatment of breast cancer. In 1998 in Australia, out of the total of 10,661 women who were newly diagnosed with breast cancer, 4,638 women were considered eligible for chemotherapy. Of these 4,638 women, only 164 (3.5 percent) actually gained some survival benefit from chemotherapy. As the authors point out, the use of newer chemotherapy regimens including the taxanes and anthracyclines for breast cancer may raise survival by an estimated additional one percent – but this is achieved at the expense of an increased risk of cardiac toxicity and nerve damage.
    “There is also no convincing evidence,” they write, “that using regimens with newer and more expensive drugs is any more beneficial than the regimens used in the 1970s.” They add that two systematic reviews of the evidence been not been able to demonstrate any survival benefit for chemotherapy in recurrent or metastatic breast cancer.
    Another factor clouding the issue is the growing trend for clinical trials to use what are called ‘surrogate end points,’ as a yardstick by which to measure a chemotherapy regimen’s effectiveness. This is instead of using the only real measures that matters to patients – prolongation of life as measured by overall survival and improved quality of life. Surrogate end points such as ‘progression-free survival,’ ‘disease-free survival’ or ‘recurrence-free survival’ may only reflect temporary lulls in the progression of the disease. Such temporary stabilization of disease, if it occurs at all, seldom lasts for more than a few months at best. The cancer typically returns, sometimes with renewed vigor, and survival is not generally extended by such interventions. However, trials reported in terms of surrogate end points can create the illusion that the lives of desperately ill patients are being significantly extended or made more bearable by chemotherapy, when in reality this is not the case.
    In summary, the authors state:
    “The introduction of cytotoxic chemotherapy for solid tumors and the establishment of the sub-specialty of medical oncology have been accepted as an advance in cancer management. However, despite the early claims of chemotherapy as the panacea for curing all cancers, the impact of cytotoxic chemotherapy is limited to small subgroups of patients and mostly occurs in the less common malignancies.”

    Splitting Hairs

    In view of the highly controversial nature of the study’s findings, one might have expected it to receive enormous international attention. Instead, media reaction has been largely limited to the authors’ native land of Australia; the study received almost no coverage whatsoever in the US. In fact, although the paper appeared in December 2004, there was limited coverage even Down Under. The authors were interviewed for the Australian Broadcasting Corporation (ABC) program The Health Report in April 2005. But their landmark paper did not come to most doctors’ attention until a widely distributed medical practice periodical, the Australian Prescriber, ran an editorial on the study early in 2006.
    On ABC’s The Health Report, Prof. Morgan, the paper’s principal author, reiterated the study’s conclusions that chemotherapy had been oversold, and pointed to the fact that relative risk reduction is being used as the yardstick of efficacy, with its deceptively large percentage differences.
    For balance, the show host, Norman Swan, interviewed Prof. Michael Boyer, chief of medical oncology at Australia’s Royal Prince Albert Hospital, Sydney. Unable to deny the validity of the study’s essential findings, Prof. Boyer instead attempted to nitpick the authors’ methodology. He suggested that the figure for chemotherapy’s efficacy was actually somewhat higher than the study had concluded. Yet even so, when pushed, the most favorable figure he could come up with was that chemotherapy might actually be effective in 5 or 6 percent of cases (instead of around 2 percent).
    Interviewed by Australian Prescriber, Prof. Boyer similarly commented: “If you start…saying how much does chemotherapy add in the people that you might actually use it [in], the numbers start creeping up…to 5 percent or 6 percent” (Segelov 2006).
    In my opinion, this sort of hair-splitting damns chemotherapy with faint praise. It actually confirms the central message of the three critics’ study. If the best defense of chemotherapy that orthodox oncology can come up with is that it may actually be effective for 5 or 6 percent of cancer patients, rather than merely 2 percent, then surely it is high time for a radical reassessment of the widespread use of this toxic modality in cancer treatment. Either figure – 2 percent or 6 percent – will come as a shock to most patients offered this type of treatment, and ought to generate serious doubt in the minds of oncologists as to the ethics of offering chemotherapy without explicitly warning patients of its unlikely prospects for success.
    It was also astonishing that the orthodox Prof. Boyer complained that one of the major shortcomings of the study was that it insisted on measuring absolute instead of relative benefits. Asked by the interviewer whether there weren’t violations of informed consent implicit in the way that benefits of treatment were usually presented, Prof. Boyer defended the use of the more impressive-sounding relative risk reduction:
    “One of the problems of this [Morgan, ed.] paper is it uses absolute benefits rather than relative benefits,” he protested: “…the relative benefit is about a one third reduction in your risk of death.”
    This, of course, is precisely the reverse of the argument made by the study’s authors, who clearly demonstrated the misleading nature of relative risk reduction as a means of describing the efficacy of chemotherapy.

    Other Critics Emerge

    Prof. Morgan and his Australian colleagues are not alone in criticizing the pervasive use of relative risk as a means of inflating treatment efficacy. There have been others in recent years who have also voiced concern about this trend. For example, in a letter to the editor of the medical practice journal American Family Physician, James McCormack, PharmD, a member of the faculty of Pharmaceutical Sciences, University of British Columbia, made this same point about relative vs. absolute risk with great clarity.
    Dr. McCormack took as an example the prescription of the bisphosphonate drugs in the treatment and prevention of osteoporosis…but identical issues apply to the use of anticancer drugs. The journal in question had written that one of those drugs produced almost “a 50 percent decrease” in the risk of new fractures. Addressing himself to a hypothetical patient, Dr. McCormack reinterpreted this statement in terms of absolute risk: “Mrs. Jones, your risk of developing a…fracture over the next three years is approximately 8 percent. If you take a drug daily for the next three years, that risk can be reduced from 8 percent to around 5 percent, or a difference of just over 3 percent.” Of course that sounds far less impressive than saying that taking the drug will decrease the risk of fracture by almost half, even though technically both are mathematically accurate ways of expressing the benefit to be gained by the therapy.

    The Good News and the Bad

    News concerning conventional cancer treatments seems to come in two varieties: good and bad. Good news, meaning that conventional treatments work well, often generates widespread press coverage and enthusiastic statements from health officials. On the other hand, bad news, such as the fact that conventional treatments have generally been oversold, usually comes and goes unseen, attracting no media attention whatsoever.
    An example of the first kind is the recent announcement that for the first time in 70 years, the absolute number of US cancer deaths had fallen. Andrew C. von Eschenbach, MD, director of the US National Cancer Institute (NCI), called this “momentous news.” Similarly, Dr. Michael Thun, head of epidemiological research for the American Cancer Society, said it was “a notable milestone.” How big was the celebrated decline? As we reported in a recent newsletter, deaths actually fell by a total of 370, from 557,272 in 2003 to 556,902 in 2004. Expressed as a percentage of the total, it represents a drop of seven hundredths of one percent (0.066 percent).
    Contrast the wildly enthusiastic coverage given to this tiny improvement in the annual cancer death rate with the almost total media blackout (at least in North America) on this critical paper from Australia. Yet nothing can obscure the fact that chemotherapy, for most indications, has far less effectiveness than the public is being led to believe. Dr. Morgan and his colleagues deserve every reader’s gratitude for having pointed this out to their colleagues around the world.

    –Ralph W. Moss, Ph.D.
    References:

    Australian Broadcasting Corporation (ABC) Health Report – Available from:
    http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s1348333.htm
    Bucher HC, Weinbacher M, Gyr K. Influence of method of reporting study results on decision of physicians to prescribe drugs to lower cholesterol concentration. BMJ. 1994;309:761-764.
    Chao C, Studts JL, Abell T, et al. Adjuvant chemotherapy for breast cancer: how presentation of recurrence risk influences decision-making. J Clin Oncol. 2003; 21 (23):4299-4305.
    Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol). 2004;16(8):549-60.
    Segelov, E. The emperor’s new clothes – can chemotherapy survive? Australian Prescriber. 2006; 29 (1):2-3

  4. beatis March 28, 2009 at 10:18 am

    @ Natalie,

    According to Professor Morgan, the aim of the study was:

    We undertook a literature search for randomised clinical trials reporting a 5-year survival benefit attributable solely to cytotoxic chemotherapy in adult malignancies.

    First of all, you must bear in mind that surgery and not chemotherapy is the primary therapeutic modality for most cancers, especially early stage. Most forms of chemotherapy are not given as the sole cure for cancer, but either as an “adjuvant” or as a palliative.

    Palliative
    If it’s been determined that cancer cannot be cured, doctors may still suggest chemotherapy to shrink the cancer, relieve the symptoms or give the patient a longer life by controlling the cancer or putting it into remission.

    Adjuvant
    “Adjuvant” means “auxiliary.” This means that adjuvant chemotherapy is not given to cure the cancer but to help lower the risk of the cancer coming back after surgery. In breast cancer for example, adjuvant chemotherapy can increase 10-year recurrence-free survival with 5-7 %.

    Then there also are a lot of cases where no chemotherapy is given, for example in women with small breast cancers and non-metastatic lymph nodes. They ususally have a lumpectomy, followed by radiation, but no chemotherapy. Yet these cases are included in the study.

    For some kinds of cancer, chemotherapy is given as a cure. Some forms of cancer can even be cured completely with chemotherapy alone. Examples of cancers where chemotherapy works very well are testicular cancer, Hodgkin’s lymphoma, some forms of cancer in children and leukaemia. However, most of these were not included in the study

    I see you’ve placed the link in your comment to the transcript of the interview by the Health Report with Professor Graeme Morgan, who undertook the study, and Professor Michael Boyer, Head of Medical Oncology at Sydney Cancer Centre: http://www.abc.net.au/rn/talks/8.30/helthrpt/stories/s1348333.htm I think this is worth reading carefully.

  5. beatis March 28, 2009 at 10:28 am

    The journal in question had written that one of those drugs produced almost “a 50 percent decrease” in the risk of new fractures. Addressing himself to a hypothetical patient, Dr. McCormack reinterpreted this statement in terms of absolute risk: “Mrs. Jones, your risk of developing a…fracture over the next three years is approximately 8 percent. If you take a drug daily for the next three years, that risk can be reduced from 8 percent to around 5 percent, or a difference of just over 3 percent.” Of course that sounds far less impressive than saying that taking the drug will decrease the risk of fracture by almost half, even though technically both are mathematically accurate ways of expressing the benefit to be gained by the therapy.

    I honestly don’t understand why it should be reprehensible to say “50 percent” when indeed it is 50 percent. What people must realise is that the first question they have to ask themselves is: 50 percent of what? Must we really blame doctors for the fact that people don’t understand their numbers? One day when I was walking my dogs during chemo, I met a lady who told me, in a very triumphant tone, that by living a healthy lifestyle I “could have reduced the chance of developing breast cancer by 50 percent!!” Fifty percent of what, I asked. Well, of 100 ofcourse! she said. When I explained to her that not all women – 100 – but only 8-9 11 percent – that is, 9 11 at most of every 100 – develop breast cancer and that therefore a reduction of 50 percent equals 4-5 5.5 percent of 100, compared to 8-9 11 percent of 100, she was very indignant about the fact that “they” had been fooling us and she also blamed me for “tweaking statistics”. She was not the only person I have met who didn’t know the first thing about numbers and percentages. It boggles the mind.

    Edit: it seems that of every 100 women, approx. 11 develop breast cancer.

  6. jli March 29, 2009 at 2:01 pm

    @ Nathalie

    Hi Nathatlie.
    I´ve been away for a few days, which is why I haven´t responded before now. I don´t have access to the article from home, so I can´t really assess the conclusions in detail. But I think the question is important. As Beatis pointed out chemotherapy is used in two contexts:

    1) To reduce the risk of relapse/emergence of distant metastasis later in patients with “high risk cancers” that have been completely removed, and no trace of cancer is present in the body. In short as a precautionary measure. This is the group where I would expect the benefits in terms of 5 years survival would be greatest.
    2) Patients where cancers are widely spread already. In this group 5 years survival is low even when given chemotherapy.

    I can´t see from the summary whether the authors payed attention to this.

    Some cancers are more chemo-sensitive than others. It is wrong to pool all cancers together and make a general conclusion on chemotherapy from that. I can´t see from the abstract that they have done that, but from the transcript of the radio broadcast you linked to that seems to be the case:

    Michael Boyer: … That 2% figure is achieved by including a whole series of diseases in which chemotherapy would never be used.

    To me this suggests that studies showing no effect of chemotherapy of particular cancers are published (not suppressed by “big pharma”), and chemotherapy is consequently not implemented as standard treatment of those cancers.

    I can not tell from the summary how many of the studies they looked at, that were comparisons between different kinds of chemo-treatments. But again according to the transcript there is at least one:

    It’s a paper that compares two different sorts of chemotherapy and finds there’s no difference between those two sorts of chemotherapy. That’s a far cry from saying that chemotherapy versus nothing is ineffective.

    That sort of studies are quite common. These studies also report side effects. If studies on new treatments show only minor (or no) improvement on survival, they still might be useful if the side effects are lighter.

    So what would happend if cancer patients opted for alternative treatment instead of chemotherapy? Not many studies have been carried out adressing that question. But in a study on breast cancer http://www.ncbi.nlm.nih.gov/pubmed/16978951?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

    The authors found:

    By refusing chemotherapy, 9 patients increased their estimated 10-year mortality rate from 17% to 25%.

    The number of patients is small, but in that study the long term benefit of chemotherapy was higher than 2%. Given that breast cancer often progress slowly it is possible that the difference wouldn´t have been that clear after only 5 years of follow-up.

    One known problem with chemotherapy which we have discussed before is that different patients experience different responses. In a few patients the cancer will go into complete remission while other patients only experience side effects. In the next couple of years I believe we will see the emergence of tests that will be able to help in selecting those for chemotherapy who will benefit. Today we examine bowel cancers for something called “K-RAS mutations”. If they are mutated they will not respond to a particular form of chemotherapy directed at “EGFR-receptors”, and consequently the patients are not offered that kind of chemotherapy.

    Hmm.. This was a bit of a long answer to something that I couldn´t assess in detail🙂

    Hope my thoughts made some sense to you

  7. beatis March 29, 2009 at 2:41 pm

    @ Natalie,

    There is a lot of research going on aimed at finding out if it is possible to cut down on the numbers of chemotherapy.

    Until a short time ago, almost 9 out of 10 women with curable breast cancer were advised to take adjuvant chemotherapy after surgery. Adjuvant chemotherapy is given as a security measure, to destroy any micrometastases in the body. Micrometastases are undetectable – which means that there is no way of knowing if they are there. When you can detect them, it’s usually too late to do anything about them. As not every woman has these undetectably small metastases, many women received chemotherapy while not actually needing it.

    The Netherlands Cancer Institute has developed a test that can predict with a very high rate of accuracy whether breast cancer is inclined to metastasize quickly. Women with these kinds of cancers are very likely to already have micrometastases (undetectably small metastases) at the time of their lumpectomy or mastectomy, even when they have “clean” lymph nodes . Micrometastases of these kinds of cancers often respond well to chemotherapy, so those women will benefit from adjuvant chemotherapy, while for patients with other kinds of cancers no chemotherapy is needed. The technique is called microarray-mamaprint. The result will be that only women who really need it, will receive adjuvant chemotherapy. The number of women having to undergo adjuvant chemotherapy is expected to decrease considerably with the help of this technique. More information can be found here: http://humangenetics.suite101.com/article.cfm/gene_expression_of_metastatic_breast_cancer. The Netherlands Cancer Institute started working with Mamaprint January 2009.

  8. natalie March 30, 2009 at 11:01 pm

    @Beatis and Jli

    sorry for my delayed reply also!

    thanks for your comments…
    Im still a bit unclear however…

    Anyway… I agree the methodology is somewhat off key… but then as a student in the process of conducting my own dissertation I have found there are always flaws to be had with any methodology, perhaps Dr Morgan could re look his investigations to include all cancers and to not pool them all together, I would be most interested in seeing the results of Bowel cancer for example on its own and just how well chemo at say stage IV is actually beneficial…

    Beatis
    “She was not the only person I have met who didn’t know the first thing about numbers and percentages. It boggles the mind.”

    Unfortunately many people aren’t as up to speed with their numbers and percentages as for example yourself🙂 , I remember hearing for the first time myself that chemo had a 50% chance of effectiveness… ( Of what.. exactly??)Just being in shock from hearing of a loved ones new diagnosis was enough to simply nod and accept what the doctor was ordering… Yes we are resposnible for ensuring we understand fully what is going on with our treatments, however surely it is the doctors duty of care to ensure this is clearly communicated also… and that patients have a 100% clear understanding of the prognosis and outcomes.
    fortunately for us now, my sister has queried our mums oncologists insistance on getting my mum back on chemo, again he has said a 50% increase in response rate… when my sister then questioned what exactly that translated to… a mere 4 months instead of 2 months was given…

    Anyway my point is, that even if the figures increase to the equivalent of 6% … this is still not a joyous figure…( not for late stage cancers anyway, not for me…) and if that’s the best we have so far… how many more years is it going to take…

    thanks for your comments again
    on a brighter note…
    it is good to know Beatis that “There is a lot of research going on aimed at finding out if it is possible to cut down on the numbers of chemotherapy.” I certainly hope that it will be the case with not only breast cancer but all cancers..

  9. beatis March 31, 2009 at 4:55 am

    even if the figures increase to the equivalent of 6% … this is still not a joyous figure…( not for late stage cancers anyway, not for me…)

    I know. In spite of some progress having been made the past couple of years, figures for late stage cancers are not very good anyway, with or without chemotherapy.

  10. beatis March 31, 2009 at 9:51 am

    however surely it is the doctors duty of care to ensure this is clearly communicated also… and that patients have a 100% clear understanding of the prognosis and outcomes.

    Yes, absolutely.

  11. jli April 10, 2009 at 7:13 am

    Natalie wrote:

    … but then as a student in the process of conducting my own dissertation..

    Good luck from me🙂

    I would be most interested in seeing the results of Bowel cancer for example on its own and just how well chemo at say stage IV is actually beneficial…

    Been nosing around a bit. Most agree that 5 year survival rate for stage IV bowel cancer is around 8-15 %. One difficulty in answering the question exact is that stage IV is very variable. Some patients only have a few small metastasis, which are surgically removable. Others have multiple metastasis. Both are stage IV, but the first subgroup do live longer.

    surely it is the doctors duty of care to ensure this is clearly communicated also… and that patients have a 100% clear understanding of the prognosis and outcomes.

    Absolutely. It can be difficult to remeber/understand all what is told the first time. But then the doctor should follow up the next time.

    when my sister then questioned what exactly that translated to… a mere 4 months instead of 2 months was given…

    I´m very sorry to hear that. I never liked when the oncologists made that sort of statements. There really is great variability in how well patients respond to chemotherapy. See for instance this http://forums.about.com/n/pfx/forum.aspx?tsn=1&nav=messages&webtag=ab-coloncancer&tid=490

    “There is a lot of research going on aimed at finding out if it is possible to cut down on the numbers of chemotherapy.” I certainly hope that it will be the case with not only breast cancer but all cancers..

    It has begun with bowel cancer too. When considering treatment with drugs such as erbitux or vectabix cancers are tested for “K-RAS mutations”. If those are present the patients are not offered these drugs. You might be interested to hear of this study http://www.ncbi.nlm.nih.gov/pubmed/19179548?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
    They found that a blood test was useful in separating cancers with non-mutated K-RAS into two groups with a survival of 17,1 months and 5,9 months respectively. I believe that we will see more of those kind of studies in the near future.

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