Colorectal Cancer Part 5: Review of Medical Literature: Not All Patients Benefit From Chemotherapy

After surgery, microscopic cancer cells are still left behind in the body. As an "insurance policy" patients are told by their oncologists to undergo chemotherapy or radiotherapy (or both). The idea is to kill whatever cancer cells are left behind. But how effective is this? How valid is the assumption that chemotherapy can just do that?

I invite you to read the following research papers and give them some serious thought. Form your own opinion as to what you would want to do in the event that you suffer from early stage (Stage 2) colorectal cancer.

Scholefield J.H. in an article: "Challenges in colorectal cancer." (Book review. New England J of Medicine. September 2000. Vol: 343:893.) wrote:

"Colorectal cancer presents some of the most challenging problems for basic scientists, clinical investigators and practitioners. Surgery remains the centre of attention."

Question: All these years, why is the treatment of colorectal "most challenging?" Has the treatment protocol for colorectal cancer not been worked out yet?

Moertel, C. G. (in Chemotherapy for colorectal cancer. New England J. of Medicine. April 1994. Vol: 330: 1136-1142) wrote:

"Radiation therapy plays only a palliative role. In the past, chemotherapy resulted in only infrequent and usually transient shrinkage of the tumour. Its use is scarcely justified in view of the discomforts and costs of the treatment. However, now there have been some advances."

Question: The author is a renowned oncologist from the famous Mayo Clinic. It is most amazing to note that "in the past chemotherapy resulted only in temporary tumour shrinkage." Even shrinkage is infrequently achieved. But then, we were made to believe that chemotherapy was necessary. Was it a mistake then? Was undergoing chemotherapy in the past unjustifiable? What about the present? Is it going to be another mistake down the road? The author is implying that perhaps now, it is okay -- we are seeing some advances? Chemotherapy, even today is not a pleasant experience while some patients said they suffered badly. Besides, it still cost a lot of money. Has the present situation change?

Buyse M & Piedbois P. (in: Should Duke's B patients receive adjuvant therapy? A statistical perspective. Semin. Oncol. 2001.(Suppl. 1): 20-24) wrote:

"The benefit of adjuvant therapy, e.g., 5-FU + leucovorin, is a matter of debate for patients with Duke's B colon cancer. Five separate trials failed to show a significant benefit of adjuvant 5-FU + leucovorin compared with surgery alone."

Benson, A. B., et al. (in: American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J. of Clinical Oncology, August 2004. Vol: 22: 3408-3419) wrote:

"Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colon cancer. Therefore the routine use of adjuvant chemotherapy for medically fit patients with stage II colon cancer is not recommended."

Figueredo A. et al. (in: Adjuvant therapy for stage II colon cancer: A systematic review from the Cancer Care Ontario Program in Evidence-based Gastrointestinal Cancer Disease Site Group. J. of Clinical Oncology, August 2004. Vol: 16: 3395-3407) wrote:

"The benefits of adjuvant chemotherapy are small and not necessarily associated with improved overall survival. Patients should be made aware of these results."

With the above research results would cancer patients take a pause and think seriously enough before they "follow" what their oncologists may want them to do?

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