If the chemotherapy is working, don’t stop.
Submitted by Dr.Kattlove’s Cancer Blog
I once had an elderly patient with colon cancer that had spread to her liver; she had lived for five years on chemotherapy. In fact, about one year after starting treatment, the CT scans of her liver could no longer spot her cancer. She felt well on the treatment so we kept it up, since in those days, all we had was 5-FU, a relatively non-toxic drug as these things go.
But, after 5 years, she tired of the whole process, particularly since she lived about 20 miles away and the injections were given weekly. After a long discussion about the pros and cons of stopping treatment, we agreed to hold the chemotherapy and see what happened. Unfortunately, what happened was that her cancer returned in about 6 months and didn’t respond to the 5-FU this time around. A year later, she died.
This week’s Journal of Clinical Oncology (December 1, 2009) contains a more scientific evaluation of this issue – should chemotherapy for metastatic (widespread) colon cancer be continued or stopped after a period of time. The researchers, who were from France, treated their patients with advanced colorectal cancer with a combination of 5-FU, leucovorin and oxaliplatin. After 3 months of treatment, the patients were assigned to two groups (about 100 in each group). One group was continued on chemotherapy with 5-FU and leucovorin and the other received no further treatment until the cancer progressed.
Patients that had no further chemotherapy saw their cancer come back on average four months earlier than in those who received continuing chemotherapy. And stopping chemotherapy led to their shortened survival, also by about four months.
Of course, there are side effects to chemotherapy and those who didn’t receive extra treatment had fewer of these. Also the researchers did not measure the quality of life in the patients. Which group actually felt better? I would guess that the chemotherapy group actually would have won in this regard. Most studies have shown that the greatest detriment in quality of life occurs in patients whose cancer is active. Chemotherapy that shrinks the cancer generally makes people feel better, in spite of the side effects of the chemotherapy.
The results of this study will allow patients with advanced colorectal cancer to make an informed choice. Stop the chemotherapy and you will avoid its side effects; but the cancer will recur sooner and you will likely die sooner. Continue it and although you may experience side effects, you will likely live longer and perhaps, overall, feel better.
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