Taxol-Type Drugs Give Slight Boost To Survival Rates In Early Breast Cancer
Oct 26, 2007 | Posted by: roboblogger | Full story: EMaxHealth
“For patients, this study confirms that including taxanes in an adjuvant chemotherapy regimen for early breast cancer will improve their chance of living longer and remaining free of breast cancer”
The breast cancer drugs called taxanes, which include Taxol and Taxotere , increase survival rates when used as part of chemotherapy following surgery for cancers that have not spread, according to a new review ... via EMaxHealth
Since: Dec 05
Drug Selection in Breast Cancer Treatment
The article states that some researchers have argued that taxanes themselves are no better than other kinds of chemotherapy for breast cancer. What may support this?
The American Society of Clinical Oncologists (ASCO) says oncologists should make chemotherapy treatment recommendations on the basis of published reports of clinical trials and a patient's health status and treatment preferences.
So what about those published reports of clinical trials?
More chemotherapy is given for breast cancer than for any other form of cancer and there have been more published reports of clinical trials for breast cancer than for any other form of cancer.
According to the National Cancer Institute’s official cancer information website on "state of the art" chemotherapy for breast cancer, it is unclear whether single-agent chemotherapy or combination chemotherapy is preferable for first-line treatment. At this time, no data support the superiority of any particular regimen. So, it would appear that published reports of clinical trials provide precious little in the way of guidance (1).
In the total absence of guidance from published reports of clinical trials then, what basis are treatment regimens selected instead? ASCO says that this should be further based on a patient's health status and patient treatment preferences.
So what is being done?
Published in the journal Health Affairs is a joint Harvard/Michigan study entitled, "Does reimbursement influence chemotherapy treatment for cancer patients?" The authors documented a clear association between reimbursement to the oncologists for the chemotherapy of breast, lung, and colorectal cancer and the regimens which the oncologists selected for the patients. In other words, oncologists tended to base their treatment decisions on which regimen provided the greatest financial remuneration to the oncologist (2).
A March 8, 2006 New York Times article described the study. One of the more interesting aspects of the story was a comment from an executive with ASCO, Dr. Joseph S. Bailes, who disputed the study's findings, saying that cancer doctors select treatments only on the basis of clinical evidence (3).
Since: Dec 05
So ASCO's Dr. Bailes maintains that drugs are chosen only on the basis of "clinical evidence."
Yet Dr. Neil Love reported a survey of breast cancer oncologists based in academic medical centers and community based, private practice medical oncologists. The former oncologists do not derive personal profit from the administration of infusion chemotherapy, the latter oncologists do derive personal profit from infusion chemotherapy, while deriving no profit from prescribing oral-dosed chemotherapy.
The results of the survey could not have been more clear-cut. For first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists (who are motivated to keep off-protocol patients out of their chemotherapy infusion rooms to reserve these rooms for on-protocol patients) prescribed an oral-dose drug (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel.
In contrast, among the commuity-based oncologists, only 18% prescribed the non-remunerative oral-dose drug (capecitabine), while 75% prescribed remunerative infusion drugs, and about 40% prescribed the expensive, highly remunerative drug docetaxel (4).
While the Michigan/Harvard study showed results before the new Medicare reform, the Patterns of Care study showed results that the Medicare reforms are still not working. It is still an impossible conflict of interest.
Some oncologists prescribe chemotherapy drugs with equal efficacies and toxicities. I would imagine that some are influenced by the whole state of affairs, possibly without even entirely admitting it. There are so many ways for humans to rationalize their behavior. Social science research shows that people can be biased by self-interest without being aware of it (5).
Some taxane-induced side effects are so common, and in some instances so severe, that patients and their physicians may want to delay treatment, reduce the dose or discontinue therapy altogether. While there may be some medications to prevent or treat nausea, vomiting and decreased white blood cell counts, there are no treatments for other more serious taxane-induced side effects, like liver and nerve damage, let alone causing massive release of tumor cells into the circulation (6).
(3) http://www.nytimes.com/2006/03/08/he...71de&a... 070
(figure 37, volume 2, issue 1, 2005)
(5) Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003 Jul 9;290(2):252-5
(6) Oncol News Int'l, Vol 14,#5, May '05
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