Re: For those of you with Medline access........

From: Peter Moran (moringa_at_gil.com.au)
Date: 02/22/05 

Date: Tue, 22 Feb 2005 18:40:10 +1000

"Steph" <steph@vancouver.island> wrote in message
news:UPySd.463723$Xk.138639@pd7tw3no...
> I'd be interested in everyone's views on this article.
> I think it is one of the most important articles in the medical literature
> in the past 10 years.
  There seems to be no reason not to post the abstract and here it is. I
agree with the conclusions, from the point of view of ensuring accurate
informed consent whenever chemotherapy is offered to patients. But think
the value of chemotherapy varies too greatly over many different clinical
contexts for such *overall* calculations to be meaningful.

  If a similar calculation was performed for radiotherapy --------?

        1: Clin Oncol (R Coll Radiol). 2004 Dec;16(8):549-60. Related
Articles, Links

  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 - in process]
Peter Moran