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  • "How Much Does Chemotherapy Improve Survival?"

  • Though we often hear new cancer drugs described as game-changing

  • breakthroughs, most afford much more modest benefits.

  • In my last video, I quoted a recent editorial in the

  • Journal of the National Cancer Institute suggesting that the majority

  • of new cancer drugs don't deliver clinically meaningful benefits at all.

  • At least when they are later proven to be ineffective,

  • they're pulled from the market, right?

  • No! Even when postmarket studies show the new drugs to have

  • no clinically meaningful benefit compared to not just older drugs

  • but compared to nothing, compared to a sugar pill,

  • most chemo drugs retain FDA approval and remain on the market,

  • even at the same ridiculous prices. In fact, the most expensive drug

  • they looked at, the one costing $169,836 a year,

  • did not improve overall survival at all, and actually worsened quality of life.

  • $169,000 just to make you feel worse with no benefit.

  • Why pay a penny for a treatment that doesn't actually help?

  • And even when they do improve survival,

  • what does that actually mean?

  • Currently, the trend is for Big Pharma to design large trials that may detect

  • statistically significant, but often trivial,

  • differences in survival endpoints.

  • For example, check out this famous trial.

  • Adding this second drug, erlotinib, to gemcitabine for advanced

  • pancreatic cancer significantly prolonged overall survival.

  • Yeah, they suffered more side- effects, but we're not just talking

  • about tumor shrinkage. They lived significantly longer.

  • The placebo group only lived 5.91 months, whereas

  • the added drug group survived all the way to 6.24 months?

  • Wait a second. They only lived a third of a month longer?

  • That's just 10 days.

  • All the side-effects and expense for an average of just 10 days?

  • That's why doctors shouldn't use the statistical jargon ---

  • significant improvement in survival ---

  • while informing patients about benefits of new treatment.

  • When patients hear the word "survival,"

  • they're not thinking about a week and a half. If you put

  • all the new chemo drugs together approved over the last dozen years,

  • the average overall survival benefit is 2.1 months.

  • Now look, two months is two months, I don't want to downplay that, but

  • time and again, surveys have indicated that patients expect much more.

  • Incredibly, about three-quarters of patients with metastatic lung

  • or colorectal cancer did not report understanding

  • that their chemo was not at all likely to cure their cancer.

  • I mean, that's the primary treatment, but the chemo's not curative;

  • it's just eking out a few extra weeks or months.

  • Why weren't the majority of patients told that?

  • It's not that they were being over-optimistic,

  • explained the researcher. They were under the mistaken belief

  • that the treatment offered a chance of cure when it in fact didn't.

  • That deprives patients of the opportunity

  • to weigh the risks and benefits and make their own decisions

  • about their own body.

  • If you ask cancer patients, most want at least half a year

  • to stomach the side-effects, which suggests that most

  • cancer patients might not choose chemotherapy

  • if they knew how little they'd actually benefit.

  • But look, everyone's different. One patient they interviewed

  • said living even one week longer would be worth it;

  • whereas another said they wouldn't even want to do chemo

  • for two extra years of life; they wouldn't want

  • anything to interfere with the quality of the time they had left.

  • Either way, people deserve to know the truth.

  • I find it telling that oncologists and cancer nurses themselves

  • express less willingness to accept intensive chemotherapy,

  • given the associated toxicities.

  • Most chemo drugs are cytotoxic, meaning they work by killing off

  • cancer cells, but they also kill off some healthy cells

  • as collateral damage, which is why they can damage

  • our nerves, cause irreversible heart failure,

  • slough off the linings of our gut, or damage your immune system.

  • Drug companies frequently downplay the risks, though, for example,

  • describing this breast cancer drug as having acceptable side-effect

  • profiles for most patients, or this pancreatic cancer drug as having

  • a manageable and mostly reversible safety profile.

  • These were studies published in top medical journals.

  • Naturally, readers would take these statements to be true.

  • However, if you actually look at the data,

  • the number of serious, even life- threatening side effects was double,

  • or even five times higher on the new breast cancer drug.

  • And the manageable and mostly reversible side-effects

  • evidently weren't referring to those who were killed by the drug.

  • I like how they even included like a cheat sheet.

  • Acceptable toxicity. Acceptable to whom?

  • Manageable? Serious events and deaths can never

  • be considered manageable.

  • And feasible? Who would sign up for a drug whose toxicity

  • could only be described as feasible?

  • Favorable? Compared to what?

  • Tolerable? That's for the patient to decide.

  • And any drug that kills people can hardly be considered safe.

  • Still, patients may very well consider it worth the risk.

  • For some cancers, we've made tremendous strides.

  • Testicular cancer, for example.

  • There is greater than a one in three chance that chemotherapy

  • could enable you to survive at least to the five-year mark.

  • The same with Hodgkin's disease, a relatively rare form of lymphoma.

  • But even when researchers tried to err on the side

  • of over-estimating the benefit, for most common cancers

  • colon, lung, breast, and prostate

  • the chances appear to be more like 1 or 2 percent.

"How Much Does Chemotherapy Improve Survival?"

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How Much Does Chemotherapy Improve Survival?

  • 18 0
    Yui 發佈於 2022 年 08 月 04 日
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