Pros and Cons on Chemotherapy
I was chagrined to see the inflammatory headline and the well-intended but off-the-mark text in the article (Editorial Pages, Jan. 9) regarding cancer chemotherapy by Dr. Martin Shapiro, an associate professor of medicine at UCLA. That article, in my view, is misleading, and it should not be construed to be a “UCLA opinion”.
The headline, “Chemotherapy: Snake Oil Remedy?” tends to obscure the facts that cancer chemotherapy alone may cure substantial numbers of patients with Hodgkin’s disease, lymphoma, acute leukemia, testicular tumors, and gestational choriocarcinoma, and that cancer chemotherapy is a major part of multimodality therapy that may be curative in a variety of tumors including Wilm’s tumor, Ewing’s sarcoma, osteogenic sarcoma, breast cancer and childhood rhabdosarcoma. Furthermore, cancer chemotherapy causes frequent remissions and substantially prolongs survival in patients with a variety of cancers including ovarian cancer, multiple myeloma, and small cell cancer of the lung.
As Shapiro alludes, chemotherapy is far from optimal in non-small cell lung cancer, colorectal cancer, stomach cancer and pancreatic cancer. That does not mean, however, that for many patients with such diseases the benefit of treatment may not outweigh risks.
As a general internist, Shapiro may not have the background to know that randomized, controlled studies in fact have shown survival benefits with chemotherapy plus radiation for limited pancreatic cancer. He may be unaware of current data from a large randomized Canadian study that supports improved survival with modern chemotherapeutic treatment of lung cancer.
He also may lack the experience to have seen the pain-relief and improved functional status and quality of life in patients who respond to therapy. Shapiro may not know that life-threatening side effects of chemotherapy are rare in the judicious treatment of these tumors, or that colon cancer for instance is commonly treated without the hair loss, nausea, or bone marrow suppression that he refers to.
While it is clearly true that in these diseases a minority rather than majority of patients benefit from treatment, that doesn’t diminish the benefit of the responding minority. A patient with cancer should decide with full information whether the potential benefits of chemotherapy are worth the potential risks, and make the individual decisions that are best for him or her.
As I read Shapiro’s letter, I couldn’t help but think of the many patients I have treated who have benefited from chemotherapy, who might have not tried such therapy had they read his article. One patient, clearly an exceptional case, came particularly to mind. He is a young man whom I treated with conventional chemotherapy 12 years ago for metastatic colon carcinoma, incurable by surgery or radiation. Chemotherapy for him resulted in a disappearance of his disease, a resolution of his intractable pain, and a subsequently (to date) normal life--with the fathering of two children.
I would guess he would take issue with Shapiro’s statement that there is “no convincing evidence that chemotherapy offers any benefits whatsoever.”
GREGORY P. SARNA MD
Los Angeles
Sarna is an associate professor of medicine at UCLA and director of the Bowyer Multidisciplinary Oncology Clinic.
