Breast cancer awareness month spotlights oral mucositis: Side effect of anticancer therapy
As millions of Americans participate in educational initiatives as part of National Breast Cancer Awareness Month, they should keep in mind an important yet under-recognized consequence of breast cancer ...
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Since: Dec 05
#1 Oct 21, 2008
The most common side effects of chemotherapy like oral mucositis or thrombocytopenia (abnormally low number of platelets in bloodstream), are indications characterized by a lack of effective therapies.
Patient tumors with the same histology do not necessarily respond identically to the same agent or dose schedule of multiple agents. More effective tumor match to drug agents can avoid ineffective drugs and spare patients the side effects normally associated with these agents.
Eliminating potentially ineffective drugs from treatment regimens and formulating an optimal therapy choice for each patient can spare the patient from unnecessary toxicity associated with ineffective treatment and offers a better chance of tumor response resulting in progression-free and overall survival.
#2 Oct 22, 2008
Actually, mucositis has absolutely nothing whatsoever to do with whether the chemotherapy is working or not. This is just WRONG.
gdp, the researchers are working constantly to refine the use of chemotherapy.
There is no way at this time to 'formulate optimal therapy choice' for people as individuals -- only people as groups. A number of histological studies exist, for instance, to determine whether or not a breast tumor is hormone or HER-2 sensitive. This information helps form chemotherapy as well as decisions about AI's and Herceptin.
But thers is no way to personalize it. Even when a person should respond to certain chemotherapies, they don't always, and researchers don't know why but are working hard on this problem. AI's don't always work and Herceptin doesn't always work, and they just don't know why yet. The notion that there's something demonstrated in research that we aren't using is just wrong.
But we need to be very clear about this. Some patients think that if they aren't having side effects, the treatment isn't working. This just isn't true. Likewise, the presence of side effects does not mean that it is NOT working, either. We have those symptoms because chemotherapy is a blunt instrument. Its swing hits healthy as well as cancerous cells. Herceptin is better but can also attack some healthy cells, particularly in the heart although it isn't as common as at first feared.
The information is constantlyivolving.
gdp, if you have substantial information regarding your claims that will stand up to scrutiny, provide it, in full detail, in a way that others can find it. If you respond (as you did to me the other day) that it is up to others to find what you have find, you will not be any more credible than the "scientists" who can "prove" that the earth is really flat.
I have repeatedly asked for your evidence in a way that others can read -- for purely personal reasons. I had breast cancer two years ago. If it should come back this could be life-saving information for me as well as millions of other people over the next ten years alone.
Since: Dec 05
#3 Oct 22, 2008
So far Gail, you haven't given us any proof that mucositis has absolutely nothing whatsoever to do with whether the chemotherapy is working or not. Just your say so.
And you haven't given us any proof that therapy choice for population groups are found to be better than formulating optimal therapy for individuals. Just your say so.
Identifying molecular predisposing mechanisms does not guarentee that a drug will be effective for an individual patient. Nor can it, for any patient or even large groups of patients, discriminate the potential for clinical activity among different agents of the same class.
The problem with population averages is that they are averages. What would be more instructive would be to know the proportion of people who are outside the usual range of outcomes - the shape of the distribution curve.
If there were an equal amount of people who had no benefit and those who had four months longer life then the average would be two. In that case the drug would actually be more beneficial than the averages indicate. Those who got no benefit just wasted time, while the others did better.
Similarly for side effects. Is there any correlation between side effects and efficacy? Do those who benefit the most have fewer or more side effects? The number of people having side effects and their severity can't be determined from averages either.
This is a problem with many of the drugs being used these days. We now have probabilistic medicine, a far cry from the introduction of antibiotics, when nearly everyone had a dramatic improvement.
#4 Oct 22, 2008
gdp, once again you are distorting the facts. I did not say mucositis is "absolutely nothing." It's quite miserable, in fact. I have had it. However, you made the claim, so it is up to YOU to defend your own words.
"The problem with population averages is that they are averages. What would be more instructive would be to know the proportion of people who are outside the usual range of outcomes - the shape of the distribution curve."
Don't know know, but the researchers know that. MD's know that. That's what "significant distances" are all about. It's all related to the distribution curve.
"If there were an equal amount of people who had no benefit and those who had four months longer life then the average would be two."
Uh, no. The RATIO would be 1:2, but the average would only be 2 if you were looking at an N of 4. In addition, real statistics don't use averages. They *may* use the mean, which is related to average, but by its very name shifts the emphasis from fourth grade arithmetic to statistics.
"Those who got no benefit just wasted time, while the others did better."
That's what happens, although it is hardly wasted time to try to save one's life.
Similarly for side effects. Is there any correlation between side effects and efficacy?"
No, there's not.
"This is a problem with many of the drugs being used these days. We now have probabilistic medicine, a far cry from the introduction of antibiotics, when nearly everyone had a dramatic improvement."
Maybe some day we'll have the equivalent of antibiotics for cancers, but even then, we'll need an aresnal of drugs. Some infections respond markedly better to some antibiotics than others. Thus penicillin may be the antibiotic of choice for strep throat, but it may not be the best choice for a different infection in a different location.
"Cancer" is simply a gross description of cell deliveries. There are many kinds of cancers and a wide variety of treatment depending on the type of cancer. My friends who had melanoma had markedly different treatment than I did for breast cancer, which is how it should be, because the medical community has the research on it.
The "problem" with the drugs we use now is that they're the best we have NOW. Hopefully, twenty years from now, we'll have better. Right now doctors do the best they can.
And, by the way, medicine can do a far better job of managing side effects than they could even a few years ago. Anemia is nearly completely preventable. So is drop in immune levels. They have markedly effective nausea medicine. I had five months of chemo and very few side effects, because they were medically managed well and "headed off at the pass."
There may be certain, isolated types of treatment for which these generalities are not true, but generally speaking (and this is a breast cancer discussion), side effects do not indicate efficacy of treatment.
Since: Dec 05
#5 Dec 12, 2008
Side effects are a very important consideration for both patients and physicians when making treatment decisions particularly with newer treatments that could provide longer periods of time without advancement of disease. The costs of managing side effects in patients with cancer can be significant.
Different treatment regimens have very different side effect profiles. Cancer sufferers are taking doses of expensive and potentially toxic treatments that are possibly well in excess of what they need. Reducing the doses of treatments does not appear to affect the efficacy of drug combinations which may lead to lower cumulative toxicity.
It would seem that pharmaceutical companies are attracted to studies looking at the maximum tolerated dose of any treatments. It is suggested by some that we make the search for minimum effective doses of these treatments one of the key goals of cancer research.
#6 Dec 12, 2008
Excuse me but "possibly" in excess of what they need?
It's not YOUR life on the line. I made sure I was getting the maximum dosage. I wasn't about to go through chemotherapy without getting every possible benefit from it. In fact, reducing the dosage is often less effective, and few people are going to take the risk unless it's completely necessary.
"It would seem?" My DOCTOR chose my treatment -- not a pharmaceutical company. Who do you suggest volunteer for minimal dose treatments? What patients are supposed to gamble with their lives in that way? Not me!
Once again your agenda that all the people (all of them) involved with cancer treatment are a bunch of money-grubbing scumbags. Folks, do shop around for an oncologist. It's a very important relationship. The best single medical decision I ever made was to change oncologists.
But when you have one you trust, work with that person and be careful about what you read on line. Anyone can say anything on line, and their agenda may not be in your best interest.
Since: Dec 05
#7 Dec 31, 2008
And what you hear from Gail is precisely what she is talking about.
#8 Dec 31, 2008
I urge anyone concerned about what they have read here to print the messages out and take them to their oncologist. If you have breast cancer this is no time to be acting on blog posts from total strangers.
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