Healthy Skepticism Library item: 14948

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Publication type: news

Medew J.
Doctors call for review of cancer treatments
The Sydney Morning Herald 2009 Jan 19
http://www.smh.com.au/news/national/doctors-call-for-review-of-cancer-treatments/2009/01/18/1232213448313.html

Full text:

CANCER treatments should be independently reviewed to ensure toxic, expensive and ineffective drugs are not being overused at the expense of patients and taxpayers, oncologists say.

The chief executive of Cancer Council Australia, Ian Olver, and a Melbourne oncologist, Ian Haines, said a lack of independent research into the outcomes of cancer drugs meant it was difficult to know how effective treatments were for patients and those paying for the drugs.

Writing in The Medical Journal Of Australia, the doctors said there had been a decline in independent research over the past 10 years, with drug companies often paying doctors for their work and influencing treatment guidelines.

There had also been a shift in clinical trials from using drugs until maximum response and then stopping the treatment to avoid toxicity, in favour of using drugs for as long as they were tolerated, the doctors said.

“There are no survival or quality-of-life data to support this increase in treatment duration, which adds enormous costs if this design becomes the ‘evidence base’,” they wrote.

Australia also relied too heavily on the interpretation of clinical studies and their incorporation into guidelines by foreign clinical organisations, particularly those in the United States, which were heavily influenced by drug companies and special interest groups.

“Questions inevitably arise when pharmaceutical companies and medical device companies with a financial stake in the outcome provide substantial funding for their development and implementation, or when members of guideline committees also have substantial financial associations with industry,” they said.

Professor Olver and Dr Haines said Australia needed a comprehensive system to evaluate the outcomes of treatments, particularly after they were approved by the Therapeutic Goods Administration and listed on the Pharmaceutical Benefits Scheme.

“These approvals are often based on data from very carefully selected subgroups of patients in studies that are often designed, funded and interpreted and written by the pharmaceutical company seeking the PBS listing,” they said.

The doctors said high-quality data would help patients and their doctors achieve the appropriate balance between efficacy and toxicity of treatments.

“This high-quality data will also allow us to maximise the outcomes that we achieve from our investment into cancer treatment and research,” they said.

“We are all impatient for cures for more cancers, and directing resources to clinical research is to be encouraged. However, our ongoing routine clinical use of increasing doses of varying combinations of current toxic and expensive cancer therapies, which will not result in cure or substantial remission in many cancers, consumes enormous amounts of finite financial resources that could perhaps be better spent in other areas.”