This story provides an excellent discussion of the role patients and physicians can play in evaluating risks and benefits of chemotherapy, and determining just how much of a survival benefit a potentially toxic treatment will provide.
Several breast cancer experts and sources other than the study authors provide perspective on the novel idea of less chemotherapy for women who may not benefit as much from certain treatment regimens. Tailored chemotherapy, including no treatment at all, might be an option for women who would obtain only a small benefit from more aggressive treatment. This debate includes discussion of Dr. Donald Berry’s subgroup analysis of several large studies on breast cancer recurrence and survival benefit of chemotherapy for tumors fueled by estrogen (estrogen-receptor positive) and those not fueled by estrogen (estrogen-receptor negative).
Established clinical guidelines based on current evidence suggest that most women with invasive breast cancer should not forgo chemotherapy. Many physicians are cautious about changes in practice at this time, but some are already presenting the new data to patients and allowing them to weigh the pros and cons of treatment for their particular type of breast cancer. The story discusses two randomized controlled trials currently enrolling patients. These studies will provide more definitive data on chemotherapy regimens and help physicians and patients make more informed choices about chemotherapy.
The story does not provide enough information on the potential short-term and long-term harms of chemotherapy. There is only anecdotal evidence from one woman who developed nerve damage. Common short-term side effects of chemotherapy can include nausea and vomiting, hair loss, and fatigue. Younger women may also experience early menopause and infertility as a result of certain chemotherapy regimens. Potential, though rarer, serious long-term side effects may include: bone disorders, heart problems, blood clots and nerve problems.
Overall, this was a well-done article on a very controversial issue.
There is no discussion of the cost of chemotherapy and no mention of potential cost savings for women who might not benefit as much from treatment; however, this is not very relevant to this story, as there is a suggestion that less treatment might be better, with a cost savings implied.
Again, Dr. Berry’s subgroup analysis of several large chemotherapy trials, published in The Journal of the American Medical Association, was mentioned but the story didn’t give quantified details. The combined absolute benefit of chemotherapy for disease free survival at 5 years was 22.8% for estrogen-receptor-(ER) negative women compared with 7.0 % for estrogen receptor positive women treated with tamoxifen. The 5-year absolute survival benefit of chemotherapy for women with ER-negative tumors was 16.7 % vs. 4.0% for ER-positive women treated with tamoxifen. Nonetheless, the overall quality of the discussion warrants a satisfactory score.
The story does not provide enough information on the potential short-term and long-term harms of chemotherapy. There is only anecdotal evidence from one woman who developed nerve damage. Common short-term side effects of chemotherapy can include nausea and vomiting, hair loss, and fatigue. Younger women may also experience early menopause and infertility as a result of certain chemotherapy regimens. Potential, though more rare, long-term side effects are more serious and may include: bone disorders, heart problems, blood clots and nerve problems.
No mention of evidence from Dr. Berry’s analyses, however, the story provides an excellent overview of the changes in the field and the role patients and physicians need to play in evaluating individual risks and benefits of chemotherapy, including determining just how much of a survival benefit a potentially toxic treatment will provide. The story discusses two randomized controlled trials currently enrolling patients. These trials should provide more definitive data on chemotherapy regimens and help physicians and patients make more informed choices about whether chemotherapy might benefit them.
No evidence of disease mongering. This story discusses the idea of less treatment – not more – since it may not be as beneficial as once thought. The annual incidence of women who currently undergo chemotherapy for breast cancer is provided, as well as estimates of women who may or may not obtain a life-saving benefit from this treatment.
Many sources of information are cited and these are from trusted organizations of cancer research and information (e.g. National Cancer Institute, American Cancer Society). Dr. Berry, the lead author of the main study discussed, receives funding from several pharmaceutical companies, including Eli Lilly, Novartis and Bristol-Myers, however, the study was not funded by these companies.
Excellent discussion of chemotherapy treatment decision process, including discussion that no treatment is also an option. Certain chemotherapy treatments may carry serious risks and only small benefit for some women. For other women the benefit is greater, though this must still be weighed against the risks of treatment.
The story makes it clear that adjuvant chemotherapy is widely used in breast cancer treatment. Established clinical guidelines based on current evidence suggest that most women with invasive breast cancer and lymph node involvement should not forgo chemotherapy. Physicians are cautious about changes in practice at this time, but some are already presenting the new data to patients and suggesting that chemotherapy may be tailored to a patient’s type of breast cancer.
The story describes more tailored (often less) chemotherapy as a newer idea for women who may not benefit as much from more aggressive treatment. This idea is based on recent data regarding the benefit of chemotherapy for tumors fueled by estrogen (ER-positive) and those not fueled by estrogen (ER-negative).
No evidence this information is taken solely from a press release. There are several sources cited other than the study authors, and these sources provide perspective on the idea of less chemotherapy for women who may not benefit as much from certain regimens.
Systematic, Criteria-Driven
I miss @HealthNewsRevu popping up in my feed. Loved seeing this one today.
https://www.healthnewsreview.org/2021/06/zombie-health-care-news/
#healthcare #journalism #ethics #conflictofinterest
Puleeeeease... this 'game changer' weight loss drug causes more nausea and vomiting than a placebo. Some game, some change. My friend Gary would spank you for using the eighth word medical reporters should never, ever use. @garyschwitzer @thackerpd
https://www.healthnewsreview.org/toolkit/just-journalists-writing-tips-case-studies/7-words-and-more-you-shouldnt-use-in-medical-news/ https://twitter.com/OttawaCitizen/status/1361426796126830597
A scary @statnews Op-Ed warns that govt attempts to rein in Pharma may cut off access to "life-changing" drugs.
It takes @garyschwitzer to let us know: the author spent 10 years as Pfizer's public-policy chief. https://twitter.com/garyschwitzer/status/1360325022578053123
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like