Wednesday, August 2, 2006

Public's perception of cancer survivability; Phase I chemotherapy trials

Happy August & I hope you are staying out of the nation-wide heat-wave.

1)
The most recent Lancet Oncology has a narrative review on the public's perception of cancer survivability. It qualitatively surveys multiple reports on public understanding of cancer survivability and generally concludes that it is poor. The strongest trend they noted is a strong overestimation of lung cancer survivability and a strong underestimation of melanoma survivability. It's generally an interesting read, and places its results in the context of providers' difficulties in communicating prognoses to patients. An interesting phenomenon they discuss is cancer related websites' patient pages that generally paint positive pictures of cancer treatment & seem to "studiously avoid any reference to survival." They note that several of them have Questions for your doctor sections--few of which actually prompt patients to ask about survival or even treatment success. This includes the National Cancer Institute and American Cancer Society's websites!

Two more things to note about this article.... One, it is the first article I have seen whose search methods section begins with "
We searched Google and Google Scholar...." I can't say I endorse this trend. Second, it has this completely inexplicable graphic in the article:

(Ok well blogspot's image uploader won't work for me right now. The image is a drawn composite figure that looks like it was designed for Reader's Digest that has images of a labtech doing something unidentifiable to a wrack of test tubes; a geneaology diagram; a silhouetted family holding hands with green glowing splotches on their torsos which presumably represents radiation like it was a radionucleotide scan of some sort; and
a test tube with a cartoon DNA double helix floating out of it--this test tube is being held by what appears to be a wooden robot arm. I'm not making this up.)

The caption is
Cancer screening is generally viewed positively in the mass media. I can't for the life of me understand why this image was chosen or even drawn in the first place and it seems deserving of parody.

2)
Archives of Internal Medicine recently had an opinion piece arguing that one can argue sometimes that Phase I oncology trials have therapeutic intent. The background here is that traditionally Phase I drug trials have been conceived as 'first-in-human' trials of novel drugs whose only intent is to define the pharmacologic profile of the new agent as well as gather preliminary safety, dosing, & tolerability data. The point being is that there is no therapeutic intent to the trial--the subjects are not intended, personally, to benefit from being exposed to the trial drug. The authors here are arguing that some Phase I chemotherapy trials involve agents known to be beneficial in certain cancers, including cancers that the subjects may have--the trial is however looking at a novel combination therapy etc:

Thus, a phase 1 anticancer trial may be testing the safety and defining the appropriate doses and schedule of a novel combination of 2 well-established and known useful chemotherapeutic agents in a particular clinical setting.

The overarching theme of their argument is that subjects in Phase I trials should not, a priori, be told that the trial in which they are enrolling has no therapeutic intent. This certainly seems reasonable, under some circumstances, although not being a chemotherapy trialist I'm not sure that there is this a priori practice of forewarning all Phase I subjects that their participation in the trial has zero therapeutic intent. That is, I'm wondering if this is a rhetorical straw-man set-up by the authors to make a point. Leave a comment if you know have any light to shed on this.

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