Iatrogenic Illness and Cancer
Cancer Therapy: A Progress REPORT
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diagnosis and treatment by a qualified, licensed professional.
Cancer undefeated.
Bailar JC 3rd; Gornik HL.
N Engl J Med, 336(22):1569-74 1997 May 29.The results of this study show that U.S. cancer mortality rates in 1994 were 6% higher than in 1970. Cancer mortality rates increased steadily for nearly two decades, reached a plateau, and then decreased by 1% from 1991 to 1994. This decrease can be attributed to reduction in cigarette smoking and to early detection, but not to the effects of new treatments, which, with the exception of few rare cancers such as testicular cancer, lymphomas and leukemias, have been largely disappointing. The authors conclude, "35 years of intense effort focused largely on improving treatment must be judged a qualified failure," and argue that progress can occur only through a national commitment to prevention through reallocation of funding and shift of research focus.
Have we reduced the risk of getting cancer or of dying from cancer? An update.
Bailar JC 3d; Smith EM.
Med Oncol Tumor Pharmacother, 4(3-4):193-8 1987.The results of this study show that from 1975 to 1984 cancer incidence has increased, cancer mortality rates have increased, and survival rates have remained practically unchanged, indicating that prevention efforts and treatment modalities have been largely ineffective at modifying the course of this disease.
Cancer chemotherapy--what have we achieved?
Milsted RA, Tattersall MH, Fox RM, Woods RL.
Lancet 1980 Jun 21;1(8182):1343-6.This article evaluated mortality rates in a group of 500 consecutive cancer patients admitted to a teaching hospital in 1978. Two-thirds of patients received treatment. By August 1979, 56% of treated patients and 52% of untreated patients had died. Average survival rates were 45 weeks in the treated group versus 35 weeks in the untreated group. Nine percent of patients experienced severe complications from treatment. The cost of chemotherapy drugs accounted for almost 10% of the total hospital pharmacy budget. The authors emphasize that widespread use of chemotherapy is not justified outside rigorous clinical trial settings.
Measuring health-related quality of life in clinical trials that evaluate the role of chemotherapy in cancer treatment.
Michael M; Tannock IF.
CMAJ, 158(13):1727-34 1998 Jun 30.This article emphasizes that most chemotherapy is given for palliation, i.e., to prolong survival or to improve quality of life, but with no intent of cure. However, in patients with diffuse disease, prolongation of survival is rarely achieved, and therefore alleviation of symptoms becomes the main treatment objective. As the article reports, the majority of studies evaluating the effect of palliative treatments discuss their results in terms of tumor shrinkage (tumor remission), which does not imply a benefit to the patient, rather than in terms of improved quality of life. All trials testing the effects of chemotherapy in patients with advanced disease should include measures of patients' quality of life as primary treatment outcome. Only when these measures are incorporated in the study can treatment effectiveness be properly evaluated.
