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

From: Orac (orac_usa_at_hotmail.com)
Date: 02/25/05 

Date: Thu, 24 Feb 2005 20:07:43 -0500

In article
<421c2b34$0$255$61c65585@uq-127creek-reader-03.brisbane.pipenetworks.com
.au>,
 "Peter Moran" <moringa@gil.com.au> wrote:

> "Steph" <steph@vancouver.island> wrote in message
> news:lQRSd.475802$6l.157870@pd7tw2no...

> > Yes. Viewed as positive by the patient, and often the oncologist. But does
> > it mean anything? Just like does a reduced tumor marker mean anything?. It
> > might, it might not.
>
> I would agree with you that chemotherapy is quite often used under
> circumstances where it is not likely to do much good. When that is the
> case it should be a 2-3 month trial of relatively non-toxic agents, with the
> intention of stopping the drugs promptly if there is no obvious response or
> side effects are making life unpleasant.
>
> The reasons for any overuse of chemotherapy should also be understood.
> Firstly, even with cancers that are generally unresponsive to chemotherapy,
> occasional spectacular results occur making it difficult to predict
> outcomes. I had a patient with hepatic secondaries from colon cancer who I
> tried to discourage from having chemotherapy, because of the evidence that
> it is generally unresponsive . He had a complete remission with 5FU alone,
> and was still in remission three years later when I lost contact with him.
>
> Secondly, there is that urge to "do something". The same factors that
> cause patients, relatives, and some practitioners to try "alternative"
> treatments, when in desperate straits, are also influential within
> conventional care. So, unless external pressures based upon strict
> cost-risk-benefit analyses are applied to oncologists, chemotherapy will
> continue to expose itself to accusations of overuse.

This is true. Oncologists use chemotherapy to treat cancer. It is what
they are trained to do. (Just like surgeons are trained to treat disease
with surgery and radiation oncologists are trained to treat cancer with
radiation.) It is human nature to be loathe to admit that they are
powerless in the face of a disease that they were trained to treat.
Also, as Peter pointed out, desperation on the part of the patient and
family can make it even harder to say no to chemotherapy, even in
situations where it is very unlikely to do much good. 

-- 
Orac        |"I am not *trying* to tell you anything. I am simply not
            | interested in trying to compensate for your amazing lack
            | of observation."
            |                   http://oracknows.blogspot.com

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