Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, June 01, 2014

Eliminating Chemotherapy ...

"The vast majority of women, when they see they are going to get minimal benefit from chemo, say, 'No thanks', and I don't blame them at all. Giving chemotherapy is terrible."
"[Making informed decisions about chemotherapy represents] taking this to the next level. I think this is where the future really lies."
"Being diagnosed with cancer is terrifying. Sitting with a patient in my clinic who is convinced she is going to need chemotherapy, and I am saying to her the benefits are so small it's not worth it, then when I see her smile and this relief come across her face ... you know you are doing your job well."
"Over the years, many oncologists cursed that guideline because it probably led to such wide use of chemotherapy and probably many people were hurt."
Dr. Mark Clemons, clinical investigator of cancer therapeutics, The Ottawa Hospital Research Institute

"We treat many patients without benefit, either because their cancer does not respond or because it has already been cured surgically."
2011 study in journal Therapeutic Advances Medical Oncology

"It makes sense that if you want to subject someone to six months of really difficult treatment, a lot of which has side-effects, you should at least figure out whether it will truly work and that there is no other less toxic alternative treatment, such as anti-hormonal therapy."
"I think it is unfair to ask the patients to choose when they are in an anxious and confused state."
"[Use of chemotherapy without knowing whether it is doing any good represents] the old way of doing things. The problem is that chemotherapy is not innocent. It is toxic and hard on the patients for a very long time."
Dr. Angel Arnaout, surgical oncologist,  and researcher, The Ottawa Hospital
Dr. Angel Arnaout, (R) cancer researcher and surgeon, Dr Mark Clemons (L) and Dr Susan Robertson, (C), pathologist, have all been involved in research that tailors chemotherapy to the individual cancer patient rather than a "one size fits all" approach.  Wayne Cuddington / Ottawa Citizen

At the present time, oncologists appear in agreement that there is a place and likely always will be a place for chemotherapy in the arsenal battling cancer. In 1990 in the United States a guideline was issued claiming that "there is no group of patients who do not benefit from chemotherapy". A lot can happen in medical technology and treatment protocols in twenty years. The medical world is improving its use of chemotherapy, using it only when it is indicated for use.

The scattergun approach of the past is gone, when chemotherapy was considered routine for everyone suffering from cancer, in the urgency to remove all vestiges of the dread disease, post-surgery. It was simply accepted as a required protocol.  Things have changed, patients who once would have routinely had to undergo therapy no longer do because there are alternatives. A similar outcome with less chemotherapy has developed in breast cancer treatment.

'Personalized' medicine, still in its early stages has demonstrated that some treatments can be tailored to the needs of individual patients, replacing the model where for decades chemotherapy was the protocol medically mandated for everyone. Research and treatment guidelines are changing. National American guidelines call now for doctors to monitor more mature men with slow-growing prostate cancer, instead of administering chemotherapy.

While chemotherapy has extended countless lives since it became a standard treatment thanks to German scientist Paul Ehrlich whose work in immunology and chemotherapy  in the early 20th Century set the benchmark for cancer treatment -- earning him the Nobel Prize for Physiology one hundred years ago, becoming the major element in survival rates -- the protocol has been improved but it still exacts a dreadful price on patients.

Its purpose is to kill off rapidly-growing cancer cells, but chemotherapy makes little distinction between cells and attacks other cells as well. Patients feel dreadful throughout the process, assailed by nausea, and the inability to tolerate food, losing their hair and generally being miserable. It kills cells in the lining of the intestines, for example, and renders female patients infertile since it kills cells in their ovaries; an entirely traumatic experience.

It is latterly estimated that as many as 85% of patients with the most common form of breast cancer received unnecessary chemotherapy over the years. Doctors have improved their ability to gauge whether the process will be of benefit to a patient, and how much benefit can be anticipated, which aids patients in determining whether they feel undergoing therapy is worthwhile for them.

Dr. Angel Arnaout at The Ottawa Hospital Research Institute studies the early use of hormone-blocking agents for the most common type of breast cancer; estrogen-positive and lymph node-negative, for a more targeted treatment of breast cancer. While factors such as a patient's age, the size of the tumour are taken into account in determining how effective chemotherapy might be, Dr. Anaout's research plans to remove the guesswork.

Her protocol involves the administering of a anti-estrogen medication to those whose tumours are  hormone sensitive, directly after diagnosis. Most breast cancer tumours are a fit for this process. Where once patients would submit to this treatment along with chemotherapy, radiation and surgery, things are changing. With the use of Dr. Arnaout's research findings doctors can be aided to determine whether anti-estrogen therapy on its own would be sufficient.

Mathematical modelling, according to Dr. Clemons, also helps patients to make informed decisions. In 49% of patients, tumours were suppressed significantly or their growth was halted within weeks; an outcome suggesting those patients would have no need for chemotherapy. Dr. Arnaout anticipates that oncologists will gain enough information about the individual tumour's genetic makeup and the manner in which they respond to hormone blockers to enable them to turn away from chemotherapy as an option.

Even so, when it's use is required, chemotherapy treatment has become more targeted for greater effectiveness and to produce fewer side effects. Drugs to reduce and control side-effects have significantly advanced over the years. And now as well, new research therapies are advancing using the body's immune system and oncolytic viruses to fight cancer.

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