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

From: J (virtual_at_privacy.net)
Date: 02/22/05 

Date: Tue, 22 Feb 2005 11:36:03 -0500

Steph wrote:

> "J" <virtual@privacy.net> wrote in message
>
> > Peter Moran wrote:
> >
> >> "Steph" <steph@vancouver.island> wrote in message
>
> >> > 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.
> >
> > Same point made here.
> >
> > Questioning methodology - accusing them of statistical gymnastics.
> > This seems to be making 3 points:
> > Some cancers/stages do respond (maybe I saw that elsewhere - mentioned
> > testicular)
> > The authors did not include people with mets and/or see Colon Duke C ?
> > The authors ignore the positives of partial responses at year 1, 2, 3, 4
> >
>
> The paper is very careful to state that it only includes people being
> treated with curative or adjuvant intent, not patients with metastatic
> disease.
> It also points out that the survival improvements from chemotherapy for
> patients with metastatic disease would certainly be even less.
> What positives of partial responses are you referring to?

Well, if a tumor shrinks or lesions disappear at year one or two (on chemo),
that's viewed as a positive by the patient.

> The paper didn't
> try to address that.
> Read the entire thing, not just the abstract

Ok thanks and/or but I don't have it and if it requires subscription, I won't
until readily available to the rest of us.
Thanks,
J

> Bottom line:
> Of the 22 most common adult cancers (excluding non-melanoma skin cancer),
> there is evidence of a survival benefit from chemotherapy in only 9.
> The overall benefit is 2.6%
> If the three cancers with a proven track record with chemo (Hodkin's
> lymphoma, NHL and testis germ cell) are excluded, the overall advantage is
> 1.4%.
>
> I think the maths is very robust, and based on very firm data.
> It's also not a surprise to me as an oncologist.

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