Should You Take Chemotherapy for Cancer?
Know Your OS, PFS, and QOL Numbers, Please!
Majid Ali, M.D.
Should a person accept chemotherapy in the treatment of cancer? This question is simple and the answer is straightforward in some cases. It is most troublesome in other cases. Most childhood cancers respond well to chemotherapy, largely, in my view, because their oxygen-governed cancer-fighting defenses are usually strong. In most cases of cancer in adults, however, chemotherapy has very limited benefits at an enormous toxicity cost to the patient. In many cases, chemotherapy only robs the patient of the process of dignified passing on in the loving care of the family. In this article, I also highlight what I consider to be outright deceptions.
OS, PFS, and QOL
Most individuals who are advised to have chemotherapy for themselves or their loved ones are not even aware of the abbreviations OS, PFS, and QOL.These are widely discussed in chemotherapy literature but regrettably rarely reviewed in depth by doctors who recommend chemotherapy drugs. These are crucial matters and deserve careful consideration.
Overall Survival (OS)
In the minds of patients and their families, the use of highly toxic drugs—most chemotherapy drugs fall in this category—is justified only to save or meaningfully( prolong lives. So the OS facts must be deemed as the most important concern. In reality, in discussion with patients, doctors seldom draw a sharp distinction between OS information from what is called progression-free survival (PFS) and quality-of-life (QOL) matters. The common practice is to begin with words such as “In my opinion, the treatment is necessary” and not even bring up the subjects of progression-free survival and quality-of-life.
The PFS Distortion
The very notion of progression-free survival (PFS) was developed and promoted by drug companies to justify the use of chemo drugs which did not—and do not—allow the patient to live longer. It is shocking to see how widely the OS numbers are being substituted with PFS endpoints. It is sad to recognize how little concern is being shown on this crucial matter by the oncology community. Consider the dramatic rises in the use of PFS endpoints (rather than OS data) used by FDA for new drug approval, as reported by the Journal of Clinical Oncology:
FDA Approval of Drugs on the Basis of Progression-free Survival (PFS)
Before 1984 None
1985 to 1994 2%
1995 to 2004 7%
2005 to 2009 26%
Have you ever seen this crucial matter duly presented in the media? Or even properly reviewed by doctors when chemotherapy is prescribed?
Chemotherapy Often Makes Cancers More Aggressive
I anticipate this question from the reader: If a drug prolongs progression-free survival (PFS), how is that it does not show un in OS numbers? There are three issues here:
1. First, tumor progression as measured by scans is notoriously unreliable.
2. Microscopically, chemotherapy makes cancer more aggressive.
3. Clinically, tumors generally spread more rapidly when they resume growth after the initial shrinkage with chemotherapy.
The QOL Distortion
As for the matter of quality of life (QOL) during and after chemotherapy, the only acceptable criteria are as defined by the patient or by the family members closely caring for the patient. Amazingly, such quality-of-life assessments are dismissed by doctors as “subjective” and therefore unacceptable.
Failed Chemo Drug – The Predictable and the Predicted-Comes True
In my two-volume book on cancer (available at http://alibooks.org/), I predicted that certain angiogenesis-inhibitor drugs, such as Avastin, will prove to be failed drugs. That prediction came true when FDA revoked its approval of Avastin for breast cancer (see the article linked below for details).
Protecting Oneself From Chemotherapy Toxicity
Strong nutritionmal status is crucial for protection from toxicities of chemotherapy. For people interested in learning basic, simple, and important aspects of the science of nutrition, I offer “Dr. Ali’s Course on Nutrition.” which can be downloaded by clicking at the boxes below.