Concerns about chemotherapy are legitimate

BMJ 1996;312:1417 (1 June)

Letters

Concerns about chemotherapy are legitimate

EDITOR,--Maurice L Slevin's editorial on adjuvant treatmentin colorectal cancer reflects the prevailing conviction amongoncologists about the beneficial effect of chemotherapy on survivalin this disease.¹ Unfortunately, Slevin probably overestimatesthe real effect because he selectively emphasises particulartrials that have reported a survival benefit while ignoringother studies, testing identical regimens, in which no benefitwas apparent (N Wilking, Stockholm colorectal cancer symposium,Stockholm, 12-13 Oct 1995).² ³ Moreover, even in those trialscited, the reported improvements in survival are only moderate,the confidence limits are wide, and the apparent effect is restrictedto patients with positive nodes (type C disease).

The proportional reductions in the risk of dying, as used bySlevin, give a misleadingly optimistic view of the benefitsin terms of absolute survival. It is more appropriate here touse the "number needed to treat" method.⁴ In the non-adjuvant"therapeutic desert" referred to by Slevin 100 . . . [Full text of this article]

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