Chemotherapy
Questions that every patient should ask their oncologist:
- What do you think caused my cancer? Is that a guess?
- Will the therapy you are recommending remove the cause of my cancer?
- Even if this treatment removes all of the cancer, what will this treatment do to help prevent a return of the cancer?
- Chemotherapy has been shown to be curative in less than 3% of cases by a study published in the Journal of Clinical Oncology. https://www.ncbi.nlm.nih.gov/pubmed/15630849 That is worse than the benefits of placebo. Is the therapy that you are recommending considered to be curative, adjuvant, neoadjuvant or palliative? (See below for definitions)
- Please give me a list of ALL of the medications that you will be recommending I take as part of this therapy.
- What are the side effects of the recommended treatments? How likely is it that this treatment will be detrimental to the quality of my day-to-day life?
- What percentage of patients with my diagnosis have been cured by this treatment?
- What percentage of your patients with my diagnosis are now considered cancer free?
- If a cure is not considered possible, then what can I expect from the treatment?
- Please put me in touch with at least 5 patients in a similar situation so that I can speak to them regarding the effectiveness of the treatments and their quality of life.
- Before treatment, will I be required to sign a legal waiver which releases the hospital and/or you from liability from any harm that may be done to me by the treatments? What legal recourse will I have if harm is done to me?
- How much will my treatment cost me?
- If you order a CT scan, PET scan MRI, or a chemotherapy drug, how much will you make from those procedures or medications?
- How much will you make from my treatment? How much will the hospital make?
Theoretically, there are four main ways that chemotherapy is used to treat cancer:
Curative Chemotherapy:
Chemotherapy can be the primary (and sometimes only) treatment for cancer. This is common in hematological malignancies, like leukemia and lymphomas, where it’s usually some combination of chemotherapy ± radiation therapy that is curative. Surgery is rarely indicated. The intent here is to use chemotherapy to eliminate cancer from the body.
Curative Chemotherapy:
Chemotherapy can be the primary (and sometimes only) treatment for cancer. This is common in hematological malignancies, like leukemia and lymphomas, where it’s usually some combination of chemotherapy ± radiation therapy that is curative. Surgery is rarely indicated. The intent here is to use chemotherapy to eliminate cancer from the body.
According to the meta-study below, chemotherapy is curative in less than 3% of cases.
The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies.https://www.ncbi.nlm.nih.gov/pubmed/15630849
The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies.https://www.ncbi.nlm.nih.gov/pubmed/15630849
Adjuvant chemotherapy:
After definitive surgical treatment of the primary cancer, chemotherapy is administered to decrease the chance of recurrence. This is a very common use of chemotherapy, particularly in breast cancer and colorectal cancer. Indeed, the use of adjuvant chemotherapy for breast cancer since the 1980s, among other factors, has contributed to a decline in breast cancer mortality of around 30% since 1990.
Neoadjuvant chemotherapy:
In general, there are two main reasons to administer neoadjuvant chemotherapy:
(1) to shrink a tumor to make a non-operable tumor (e.g., one stuck to major structures) operable for cure;
(2) to make organ-sparing surgery possible. This is common in breast cancer in order to shrink a tumor so that a mastectomy is not required to remove it and breast-conserving surgery is possible. The same idea is used in the surgical treatment of low rectal cancer requiring an abdominoperineal resection (APR) to remove. An APR involves removing the anal sphincter and leaving the patient with a permanent colostomy. With neoadjuvant chemotherapy, it is often possible to shrink the tumor enough to make sphincter-sparing surgery possible, something very desirable to patients.
Palliative chemotherapy:
In stage IV disease, chemotherapy is often used to palliate symptoms from growing tumors and can prolong life, although not result in long term survival. This is also a common use of chemotherapy.
After definitive surgical treatment of the primary cancer, chemotherapy is administered to decrease the chance of recurrence. This is a very common use of chemotherapy, particularly in breast cancer and colorectal cancer. Indeed, the use of adjuvant chemotherapy for breast cancer since the 1980s, among other factors, has contributed to a decline in breast cancer mortality of around 30% since 1990.
Neoadjuvant chemotherapy:
In general, there are two main reasons to administer neoadjuvant chemotherapy:
(1) to shrink a tumor to make a non-operable tumor (e.g., one stuck to major structures) operable for cure;
(2) to make organ-sparing surgery possible. This is common in breast cancer in order to shrink a tumor so that a mastectomy is not required to remove it and breast-conserving surgery is possible. The same idea is used in the surgical treatment of low rectal cancer requiring an abdominoperineal resection (APR) to remove. An APR involves removing the anal sphincter and leaving the patient with a permanent colostomy. With neoadjuvant chemotherapy, it is often possible to shrink the tumor enough to make sphincter-sparing surgery possible, something very desirable to patients.
Palliative chemotherapy:
In stage IV disease, chemotherapy is often used to palliate symptoms from growing tumors and can prolong life, although not result in long term survival. This is also a common use of chemotherapy.
