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The Cancer Journal - Volume 5, Number 4 (July-August 1992)

editorial


How to evaluate unproven methods in oncology ?



"Unorthodox therapies in oncology" is a very sensitive issue that enrages the medical establishment. Few controversies in cancer therapy have been so fierce as the laetrile issue which is still regarded as a hallmark of quackery. Then came other drugs, e.g. , hydrazine sulfate, Burton's immunological method and antineoplastons (1). What went wrong ? Why should our sane and rational society fall prey to malevolent quacks ? (2). In 1990, the Office of Technology Assessment of the United States Congress (OTA) published a report on unconventional cancer treatments (3) which was criticized by a distinguished representative of the medical establishment in the following phrases: "The report could be an almost pathognonomic symptom of a serious, chronic disease affecting our government... Its symptoms are clear-fuzzy thinking, irrationality, confusion,..." (2). For decades such utterances had a devastating effect on practitioners of unorthodox therapies. Now that NCI has officilally admitted that there is "stalemate" in the war on cancer" (4,5) the public gets suspicious of traditional treatment and unproven methods in oncology become respected (6). Next year a tumour biology center that will devote itself to alternative cancer therapies will be opened in Freiburg.

The name "Unproven methods of oncology" implies that conventional therapy has been proven to be effective, and yet in many chronic cancers, e.g., breast cancer, traditional therapy fails to cure most of the patients. Fig. 1 depicts age-adjusted mortality from breast cancer (7,8). In spite of a wealth of "proven methods", for 50 years, age-adjusted mortality from breast cancer has continuously risen. Conventional treatment, e.g., surgery, chemotherapy and irradiation, did not improve the prospect of the average cancer patient. Obviously when the patient seeks help it is already too late and the establishment turns to new technologies, e.g., biological response modifiers, and IL-2. Yet these methods are still unproven, exactly as those of quacks and charlatans, and may even fail. Why not then test the unorthodox methods like any other scientific theory ?

The expert assures us that "none of these putative treatments is unknown to the medical community. All have been reviewed and examined many times before... Some have been studied and discredited as a result of scientifically designed clinical trials" (2). These statements hide several fallacies. It is true that unorthodox methods failed to prolong patient survival, yet are the "proven" methods more effective ? None prolongs survival of adult patients with disseminated cancer ! When unorthodox therapies were tested they were usually supplemented to the traditional, which makes any comparison therapies between the two impossible. Previously such designs were justified for ethical reasons. Now that, at least in breast cancer, treatment has failed the whole issue should be reconsidered.

There is an important message in unorthodox therapy that is still ignored by the traditional. According to oncology, cure means tumor eradication and since most patients seek help when the disease is widespread they cannot be cured. It then attempts to slow down cancer progression by reducing the tumor load, while some unorthodox therapies attempt to curb cancer progression without eradicating the tumor. This is also the objective of "semi-orthodox" treatments, e.g., psychotherapy, that are still opposed by the establishment. A Stanford psychiatrist reported recently "that psychotherapy lengthened by a year and a half the lives of women with metastatic breast cancer, while reducing their anxiety and pain as well" (9).

Unorthodox ideas ought therefore be subjected to unbiased clinical trials in which their efficacy is compared with that of other methods, e.g., surgery, chemotherapy and psychotherapy, and judged by their merit to improve the quality of life and prolong remission.


G. Zajicek
e-mail: Gershom@md2.huji.ac.il
References:

1. Moss RW. The cancer industry Paragon House New York, 1989.
2. Durant JR. If it quacks... Cancer 67 : 2225-2226, 1991.
3. U.S. Congress, Office of Technology Assessment. Unconventional Cancer Treatment. OTA-H-405, Washington D.C. US Government printing office, 1990.
4. Marshall E. Breast cancer : stalemate in the war on cancer. Science 254, 1719-1720, 1991.
5. Zajicek G. Cancer starts as a systemic disease. The Cancer J. in press, 1992.
6. Hauser SP. Unproven methods in onclology. Europ. J. Cancer 27 : 1549-1551, 1991.
7 Cancer mortality in the U.S. 1950-1977. NCI Monogr. 59, 1982.
8 Silverberg E. Lubera J. Cancer statistics 1988, CA 38 : 5 5-22, 1988.
9 Barinaga M. Can psychotherapy delay cancer deaths ? Science 246 : 448-449, 1989.

Figure:

Figure 1. Age adjusted mortality rate. Breast cancer in the U.S.

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