Monday, November 10, 2008
Two more, briefly, from Journal of Clinical Oncology....
There is also a compelling editorial about the gap between patients' perceptions of the benefits of cancer therapies and reality (free full-text). It is a hard look at the language used in outcome reporting (in the scientific literature - not in the lay media - which is even more of a problem) and how that is often misleading (e.g. implying a statistically significant survival benefit represents a clinically significant benefit). It takes on 'progression-free survival' (suggesting instead 'progression-free interval') and asks the very relevant question If the death rate is reduced, how come everyone died? regarding trials involving incurable cancer and how reports of reduction in mortality can be interpreted as meaning some patients were cured.
In addition to this I'd add the mass-confusion patients have about 'response' and 'remission' and the constant touting in the lay media of 'exciting new breakthroughs' in cancer therapy. Sure, when a novel class of cancer therapies come available - or when a previously untreatable (at least with systemic therapy) cancer becomes 'treatable' (e.g. sunitnib for hepatocellular carcinoma) - that is a 'breakthrough,' and happy news. Our patients reading about that however usually aren't told (until their weary oncologist has to tell them) that it's unlikely to change the natural history of that disease for the vast majority of people who have it. Industry press-releases flooding 'consumer' news sites don't help, either.
Finally there's a letter (really an editorial) calling for more a more rigorous definition of 'best supportive care' in cancer trials.