Conquering chemotherapy

The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.

Editor, – Notwithstanding your desire to provoke correspondence, your pot boiling editorial on chemotherapy (Aust Prescr 2000;23:5) has missed the point. The palliative management of advanced cancers is extremely difficult and what you are criticising is not chemotherapy, but lousy judgement. Most treatments for cancer, including I am afraid the immunotherapy which you favour, have a low therapeutic ratio. Judgement can be enhanced by training and education programs, such as those provided by the Medical Oncology Group of the College of Physicians and the Faculty of Radiation Oncology. We should also not forget that 'merely delaying the inevitable', albeit with unpleasant adverse effects, may be exactly what the patient wishes. The care of patients with advanced cancers must be individualised.

Roger Allison
Radiation Oncologist
Royal Brisbane Hospital
Herston, Qld.

Editor, – We would like to reply to your editorial 'Conquering chemotherapy'(Aust Prescr 2000;23:5). Although you acknowledge that chemotherapy can cure certain cancers, we believe that your references to chemotherapy in the palliative situation require comment. It is true that chemotherapy, like most drug treatment, has the potential for adverse effects. Most readers would be aware that the decision to proceed with chemotherapy in the incurable patient should follow careful, realistic consideration of the odds of palliating cancer symptoms and the impact of chemotherapy on the quantity and most importantly the quality of life. Modern phase II and III studies of chemotherapy in palliative settings now include quality of life measurements as major end points. This is in contrast to the image portrayed in the editorial in which 'patients are poisoned to the edge of their existence'. The use of growth factors such as G-CSF has developed and is approved under Section 100 of the Pharmaceutical Benefits Scheme for treatment given with curative intent in malignancies such as lymphoma and adjuvant breast therapy where there is strong evidence to support the need to maintain dose intensity. Caring for cancer patients on a daily basis, we look forward to the development of new cancer therapies such as immunotherapy. Until there is sound evidence to support its routine use, however, chemotherapy will remain the major thrust of treatment of many cancers into the 21st century. We believe that the judicious use of chemotherapy should be considered in the context of the large body of evidence, including quality of life data, which reveals its worth.

Keith Horwood
Medical Oncologist

David Wyld
Director of Medical Oncology
Royal Brisbane Hospital
Herston, Qld.

Dr J.S. Dowden, Editor, and the author of 'Conquering chemotherapy', comments:

Predicting the future is not easy. I hope that in that future we will be able to offer effective, well-tolerated treatments to patients with advanced cancer. The critical comments of the Queensland oncologists clearly reflect treatment in the dying days of the 20th century. Will chemotherapy still be as important at the end of this century? I am sure that all oncologists look forward to a time when patients will not suffer from severe toxicity or from 'lousy judgement'.