When Is a Cancer Treatment Worthwhile?

Open Access
Publisher Website
Google Scholar
Abstract
In 1984 Mackillop et al.1 sent a questionnaire to physicians and surgeons in Ontario who treated lung cancer. The questionnaire asked the doctors to consider themselves as patients with lung cancer, as specified in a number of clinical scenarios, and to describe the treatment they would wish to receive. One scenario described asymptomatic, locally advanced non-small-cell lung cancer. A majority of the respondents (61 percent) preferred treatment with radiotherapy, and 22 percent preferred no immediate treatment; only 5 percent of the respondents chose chemotherapy. We do not know the reasons for these choices, but they were presumably influenced by randomized trials (reviewed by Payne2) that showed at most small benefits in survival when immediate radiotherapy was compared with a wait-and-see policy, and by six randomized trials of radiation with or without chemotherapy (reviewed by Tannock3), only one of which showed a small survival advantage for combined treatment as compared with radiation alone. The doctors were expressing the opinion that if they had cancer of a type and stage almost certain to be lethal, the side effects associated with drug treatment were not worth enduring. Has the situation changed in 1990?