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
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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