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Implications for co-payments, if they are legitimised
- Peter Kirkbride (2 September 2008)
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Palliative chemotherapy - Is consent fully informed?
- Qamar Ghafoor, Robert Grieve, Professor Of Clinical Oncology (2 September 2008)
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Peter Kirkbride, Consultant Clinical Oncologist Weston Park Hospital, Sheffield, S10 2 SJ
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The information contained in this report as well as that in the accompanying editorial, goes to emphasise the points that colleagues and I have made recently (ref); that the goalposts have moved and palliative anti-cancer treatment is now being precribed (promoted?) based on survival benefit rather than symptom control and quality of life. Most interventions in palliative oncology have been developed predominantly to improve quality rather than quantity of life, and although this aspect of treatment is mentioned in the paper, it seems that the discussions of benefit mainly centred around improved survival. How much were the patients told about these other outcomes? The second point I would like to make is that if, as I have long suspected and as this paper confirms, that oncologists are not very good at telling patients the truth about about the benefits of palliative chemotherapy, then should Prof Richards' report in October legitimise co- payments, particularly for the newer, more expensive anti-cancer therapies, unless practice changes, patients could be re-mortgaging their houses, based on false assumptions of the benefits of treatment If his report recommends that co-payments are allowable, there has to be an understanding that patients will be honestly informed of the true risks and benefits, so they can make informed decisions, and it is imperative that they are provided with more precise information on effectiveness and costs - caveat emptor - as I doubt if there will be refunds available for treatments which are unduly toxic or ineffective. Reference: Kirkbride P, Tannock IF. Trials in palliative treatment—have the goal posts been moved? The Lancet Oncology - Vol. 9, Issue 3, March 2008, Pages 186-187 Competing interests: None declared |
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Qamar Ghafoor, Specialist registrar, Clinical Oncology University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, Robert Grieve, Professor Of Clinical Oncology
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Dear Sir, We read with interest the editorial and paper (1) about informed consent and palliative chemotherapy. This provides a salutary reminder to all those involved in informing patients of the likely benefits of treatment with response rates of less than 50%, that treatment may cause more harm than good. The human condition demands us all to have a positive outlook and patients therefore anticipate that they will be in the responding groups in this situation, contributing to the high take-up of chemotherapy where survival may be very limited. Sadly the quality of life is poorly recorded in the most advanced cancer trials and little is reported on the quality of life in non- responding patients who may well form the majority of treated cases. What additional problems are added to the effects of progressive malignancy remains difficult to identify without studies comparing palliative chemotherapy against best supportive care. Whilst response rates, median duration of response and overall survival benefit are fundamental to late stage trials, the quality of life assessments should become an essential part of such ongoing studies so that we can present better informed advice, especially in those cases with a very limited outlook. 1. Audrey S, Abel J, Blazeby J, Falk S, Campbell R. What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study. BMJ 2008; 337:a752. Competing interests: None declared |
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