Oncologic hypocrisy

AlaskaAngel · Posted: Mon Nov 22, 2004 2:15 pm Post subject: Oncologic hypocrisy

Hi Leo.

I was diagnosed with HER2+ bc at the end of 2001 and like most, had a lot to learn but little time to make decisions about treatment. Since then I have explored a number of bc "decision guides/tools" online. It seems to me that it is more than just a little hypocritical for oncs to routinely recommend using chemo that includes an anthracycline for patients who are HER2+ and yet they can't come out of the closet to agree on that enough to put that criteria in the online decision guides. Has ASCO ever come out with a consensus statement on this? If so, why wouldn't it be included as part of the online decision guides?

It is deceptive not to include this in the decision guides, particularly since anthracylines pose some additional potential dangers. Why should we have to continue to rely on what each onc "thinks" and "recommends" if they aren't basing that on a consensus after considering what evidence there is?

leo · Contributor Joined: 23 Sep 2004 Posts: 1575

Hello

Thanks for your post. I agree with you that since the evidence is available, it should be applied uniformly to all patients. While that is true, there is so much that influences if a patient can receive more aggressive treatment that I think it is not possible to include in these decision guides.

For example, take bone marrow transplant for leukemia. Some doctors offer it to patients up to 45y, other go up to 50y and so on. It is the level of comfort that an individual doctor has with submitting a patient to a very aggressive treatment regimen. Another example, if an 85 yo woman who has very aggressive breast cancer is being evaluated, few would offer her aggressive chemotherapy with anthracyclines. But some would. Oncology is such a difficult field mainly because there are so many difficult decisions to make....

Guidelines or consensus are just that: a group of experts that come together an issue a statement. When there is controversy, guidelines are usually not issues because the is no consensus...

Hope this helped !

regards,
Leo
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Disclaimer: this information is for informational purposes only. It is not medical advice.

AlaskaAngel · Posted: Mon Nov 22, 2004 8:00 pm Post subject: HER2 and anthracyclines

Thanks for the response, Leo. I know the reason for having decision guides in the first place is to try to explain and simplify the complicated nature of breast cancer.

I still believe the decision guides for adjuvant treatment should at least reference the issue of HER2 and anthracyclines somewhere, because without that the results can be discordant with what most oncs would actually recommend, which tends to make one wonder if the onc they are seeing is out of touch or just tends to hand out the nastiest chemo as a rule of thumb.

A.A.

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