Wellness & Fitness

Don’t be in a hurry to recommend chemotherapy for cancer, says study

MURCANCER1902V

Children from the cancer ward at Nairobi's Kenyatta National Hospital marked Cancer Day. Doctors should not always rush to recommend aggressive treatment such as chemotherapy for certain types of cancer, a study has shown. PHOTO | FILE

Doctors should not always rush to recommend aggressive treatment such as chemotherapy for certain types of cancer, a study has shown.

The results established that for adults with advanced kidney cancer, close surveillance for evidence of disease advancement instead of the usual chemotherapy can extend their lives as opposed to conventional treatments where often-toxic drugs are administered to tame growths.

The study published in the UK medical journal, The Lancet says the observation approach was successful in cases where cancer cells had not spread aggressively to other parts of the body, and in patients not dealing with other unfavourable factors such as anaemia, thrombocytosis (high platelet levels) and disability.

All cancers

“There is a perception that all cancers should be treated immediately because they are equally lethal. But what we’ve seen in this small phase two study is that a subset of adults with advanced kidney cancer have slow-growing disease that can be safely managed using active surveillance, which could spare them the inconvenience and debilitating side effects of aggressive treatments for about a year, and in some cases several years, without worsening anxiety and depression,” says lead author, Prof Brian Rini, from Cleveland Clinic Taussig Cancer Institute, US.

“With just 50 people involved in our trial, the risk and benefits of the approach will need to be studied in a larger group of patients.”

The study says when cancer has spread to other parts of the body, drugs that stop new blood vessels from growing in tumours need to be administered to slow it down. The expensive process, researchers say, is not curative and increases the risk of stroke and heart attack.

Dr Paul Russo from the Memorial Sloan Cancer Centre, Weill Cornell College of Medicine, in New York, USA says the research provides guidance to oncologists who, when faced with a newly-diagnosed patient with renal cancer can recommend a period of close surveillance before prescribing drugs.

“There is no evidence from this study that such a period of close surveillance jeopardises the patient’s safety or survival. It remains to be seen whether current genomic research can identify genes that can be used in conjunction with the above described selection factors to better choose patients suitable for initial active surveillance,” he said.

Quality of life

In the second phase of the study, Prof Rini identified 52 adult patients from America, Spain and the United Kingdom, and followed them for more than three years (38.1 months), during which time the changes in the quality of life, anxiety, and depression were also measured at the beginning of the study, and during the surveillance period.

CT scans of the chest, abdomen, and pelvis were taken at the start of the study and then at regular intervals to assess the size of the tumour and rate at which the disease progressed. The participants were closely monitored and the patients, on the advice of their physicians, independently chose when to start treatment.

About 90 per cent (43) of the participants experienced disease progression at some point during the study, most of whom (37) started systemic therapy (use of drugs that spread throughout the body to kill cancer cells wherever it presents).

However, nearly half (20) of participants chose to remain under surveillance for an average of 15.8 additional months after disease progression. Six of those patients are still on active surveillance.

Three participants survived without the disease getting worse and two withdrew or were lost to follow up. Around half (22) of patients died during the study, but only one patient died (from brain metastasis) without ever receiving systemic therapy.

Over the surveillance period, the quality of life, and anxiety and depression scores did not change substantially, suggesting that living with untreated cancer did not cause psychological harm to patients with advanced kidney cancer.

Dr Rini of the report notes that the major limitation was that the decision to end the surveillance was left to patient and their physician.

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