Chemotherapy: Lots of Side Effects
Our technologically-advanced society is suffering from the highest rates of cancer ever seen in human history, rates that are also much higher than in less developed parts of the world. Since 1999, cancer has surpassed heart disease and has become the leading cause of age adjusted mortality for Americans younger than 85. Despite more than a hundred billion dollars in cancer research— invested largely in the development of drug chemotherapy and screening and detection techniques—we have lost the war on cancer. While there has been a slight reduction of cancer-related deaths in the last 25 years, this is largely the result of the decrease in lung cancer deaths that has resulted from a reduction in cigarette smoking during this timeframe. Mortality rates for most cancers have stayed remarkably steady.Here’s more from Dr. Fuhrman’s post:
Chemotherapy has contributed to the progress made against cancer deaths from fast-growing cancers, such as leukemia, lymphoma, testicular cancer, and childhood cancers such as osteogenic sarcoma. But for the major cancers affecting most adult Americans, chemotherapy adds less than one year of disease-free life to those treated.
In the last bullet Dr. Fuhrman brings up the issue of side effects, and he’s not alone. A new study in the Journal of the National Cancer Institute shows there are more side effects for using chemotherapy to treat breast cancer than expected. Serena Gordon of HealthDay News reports:
- A meta-analysis of chemotherapy for postmenopausal, estrogen receptor-positive women (the largest group of women with breast cancer) pooled the six largest studies to get the most accurate data on survival and complications. Here is what researchers concluded about the group treated with standard chemotherapy: “No significant survival benefit was observed.”1
- In non-small cell lung cancer (the most common type), the 5- year survival is only about 10 percent. In stage 4, when the cancer has spread to distant sites, the 5-year survival is only 1.6 percent. After looking at multiple studies, it appears that treatment generally results in a very slight improved survival rate at 1 year, but this advantage disappeared at 30 months of follow- up.2
- Even in small cell lung cancer where chemotherapy has proven effectiveness in life extension, the benefit adds only a few months of life, not years. And during this time the patient can experience serious—even life threatening— side effects from the treatment.
"When we looked at the rates of side effects commonly associated with chemotherapy, we found women experienced more hospitalizations or emergency room visits for these side effects than previous clinical trials would have estimated," said study author Dr. Michael Hassett, a clinical instructor in medicine at the Dana-Farber Cancer Institute, in Boston.Gordon reports that researchers made some startling discoveries:
The researchers looked at hospitalizations and emergency room visits in the year following the initial diagnosis for both women who received chemotherapy and those who did not.For women diagnosised with breast cancer Dr. Hassett offers this suggestion:
Women on chemotherapy were much more likely to visit the emergency room or be hospitalized for any cause than women who didn't have chemotherapy -- 61 percent compared to 42 percent.
Fever and infection were the most common causes women were hospitalized or visited the emergency room. Low blood cell counts were the next most common reason, followed by dehydration or an electrolyte imbalance.
Women who received chemotherapy also had more than $1,200 in additional health-care expenditures related to chemotherapy and more than $17,000 in additional costs for ambulatory care than women who didn't receive chemotherapy.
"Hopefully, women with breast cancer who hear about this study will understand that deciding whether or not to have chemotherapy must be made on an individual basis," Hassett said. "Women should talk with their doctors about both the benefits and risks of chemotherapy. For women with small cancers, the benefits may not outweigh the risks. On the other hand, for women with larger or higher-risk cancers, the benefits usually outweigh the risks."For more of Dr. Fuhrman's thoughts, check out these previous posts: Re-Examining Chemotherapy for Breast Cancer and Chemo: Not Always the Best Option
1. Hartman AR, Fleming GF, Dillon JJ. Metaanalysis of adjuvant cyclophosphamide/methotrexate/ 5-fluorouracil chemotherapy in postmenopausal women with estrogen receptor-positive, node-positive breast cancer. Clin Breast Cancer 2001;2(2):138-143.
2. Blackhall FH, Bhosle J, Thatcher N. Chemotherapy for advanced non-small cell lung cancer patients with performance status 2. Curr Opin Oncol 2005 Mar;17(2):135-9.