Intended for healthcare professionals


Chemotherapy for advanced colorectal cancer

BMJ 2001; 322 doi: (Published 27 January 2001) Cite this as: BMJ 2001;322:232

Please aim for accuracy rather than hard hitting headlines

  1. Magdi M Kirollos, associate specialist (
  1. Torbay Hospital, Torquay, Devon TQ2 7AA
  2. Myton Hamlet Hospice, Warwick CV34 6PX
  3. Peter MacCallum Cancer Institute, Locked Bag 1, Melbourne, Australia 8006
  4. 3 Counties Cancer Centre, Cheltenham General Hospital, Cheltenham GL53 7AN

    EDITOR—Michael and Zalcberg's editorial on chemotherapy for advanced colorectal cancer and the Colorectal Cancer Collaborative Group's systematic review of palliative chemotherapy for advanced colorectal cancer agree superficially. 1 2 This makes the discrepancy between their conclusions surprising and raises certain questions of accuracy and presentation. The editorial overplays the value of such treatment, which was more scientifically assessed by the paper.

    Firstly, the editorial's statement that there is a 35% reduction in the risk of death for treated patients is an oversimplification of the results. In the systematic review, from which this conclusion was derived, fig 2 unambiguously shows that the risk of death is only about 16% less in the treated group.2 This translates to a median survival advantage of only four months and applies only to a period between 5 and 15 months from the start of treatment. This summary is more accurate than the one derived from the more complicated and inferred statistics used in the editorial.

    Secondly, the editorial tries to make a case for a palliative value of the treatment where the paper fails to find such a benefit. It makes that case for two subgroups of patients in single studies (references 4, 5, 6 in the editorial corresponding to references 15, 22, 17 in the paper). The result of this “splitting” contradicts the overall result in the paper: “data on the effect of chemotherapy on quality of life are inadequate to draw firm conclusions about the palliative benefit of chemotherapy.”

    Thirdly, the editorial glosses over the toxicity of chemotherapy, which could not be meaningfully summarised in the systematic review.2 Additionally, the literature possibly underestimates the toxicity of chemotherapy in view of the relatively younger …

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