A recent study conducted by Dr. Suzanne Audrey, at the University of Bristol, and her colleagues found that patients with incurable cancer are often not clearly informed of what they stand to gain from palliative chemotherapy. As a result, patients may lack sufficient knowledge to make a decision based on informed consent.

The researchers observed and recorded 9 oncologists and 37 patients during consultations in which palliative chemotherapy for advanced lung, pancreas, or colon cancer was first discussed. The researchers found that in all cases, patients were told that their cancer was incurable. They were also informed about treatment options, common side effects and the associated risks in the different treatment options. However, in 8 cases, survival was not discussed at all. In an additional 18 cases, information was "vague," involving comments such as "about 4 weeks, a few months extra, and buy you some time." Moreover, only 6 patients were given numerical data about how much longer they would likely live if palliative chemotherapy were used.

"If the oncologist focuses on the benefits of palliative chemotherapy in terms of control of symptoms and quality of life, but omits information about survival benefit, the patient might assume much greater potential to prolong life than is likely to be the case," Audrey and colleagues suggest.

The authors of this study believe that oncologists should not evade the subject of life expectancy. Instead, they recommend that oncologists receive coaching on how to inform patients without taking away hope.

After a year of chest pain, Anita Steiner was ultimately diagnosed with mesothelioma. She had surgery to remove some of the cancer from her right lung, and doctors gave her only 12 months to live. Although the news was devastating, Steiner was determined to stay positive and was put on a course of palliative chemotherapy to delay the aggressive disease. The positive attitude paid off when doctors told her she was cleared of cancer.

As Steiner celebrated the great news, she suddenly got another scare. "I was trying to unpack boxes in our new house and I just kept throwing up," she recalls. "I thought I might have come out of remission - it was an awful feeling.” Steiner’s blood test came back positive but not for mesothelioma. She was in fact pregnant, something her and her husband had been trying to do with in vitro fertilization before she got sick.  "This is one miracle, meets a second, meets a third, really," says her oncologist, Ian Haines. "The pregnancy part of this is quite extraordinary, let alone it following chemotherapy for mesothelioma, which put her into remission."

At five months pregnant, Steiner is aware of the risk that her cancer will return. She refuses to think about the negatives but does get tested regularly to be safe.” I don't think it helps to dwell,” she said. “Until I get the results of these tests, I feel stressed, but most of the time I just think about the future and having a child. I want to be with that child as he or she grows up." In addition to preparing for the birth of her child, Steiner is devoting her time to warning others about the dangers associated with asbestos.

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Recently we wrote about how the combination of the drugs Alimta and Paraplatin showed an improvement in the survival rates of people with mesothelioma. Another breakthrough has been released about the combination of two treatments that resulted in effective palliative care for mesothelioma patients. Researchers from Denmark have reported that the combination of Navelbine® (vinorelbine) and Platinol® (cisplatin) is highly active in patients with newly diagnosed non-resectable malignant pleural mesothelioma. Overall, the one-year survival was 61%, the two-year survival was 31%, and the three-year survival was 4%.

The study evaluated a regimen of Navelbine and Platinol for the treatment of 54 patients with non-resectable mesothelioma. The median number of cycles of chemotherapy administered was four and there were two complete responses and 14 partial responses. The median survival was 16.8 months, and the median time to tumor progression was 7.2 months.

The researchers have concluded that these results were as good or better than currently used combinations for treatment of mesothelioma. Therefore, this drug combination merits further investigation as the results appear to be superior to previous studies with Gemzar-based combinations.

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In 2003, Congress passed the Medicare Modernization Act.  Under this bill, doctors receive less compensation for giving patients chemotherapy.  Following the passage of the Act, some officials were concerned that the new legislation would reduce the availability and quality of chemotherapy.

A new study out of Duke University School of Medicine, however, has confirmed that the Act has not affected cancer care.  Researchers found no evidence that Medicare patients had to travel any further or search any harder for oncologists willing to administer chemotherapy.

Dr. Kevin Schulman, who led the study, said, "The Medicare Modernization Act took issue with the fact that oncologists were often reimbursed too much -- sometimes as much as three times what they had paid -- for the chemotherapy drugs they were giving their patients."  Under the Act, doctors saw their reimbursements fall.

Dr. Schulman continued, "The concern was that patient care would suffer if doctors had to close their practices or scale back, making it necessary for patients to travel farther or go to inpatient facilities for treatment. Our study showed that this, in fact, has not yet occurred."

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In the June 10 edition of the British Journal of Cancer, researchers announced that a combination of two treatments resulted in effective palliative care for elderly mesothelioma patients.  Following studies on the drug Alimta, Italian researchers issued a blend of Alimta and the drug Paraplatin to 178 patients with malignant pleural mesothelioma.  Overall, the one-year survival rate was 64% and the disease control rate was 76%.

The subjects of the study were also examined according to age.  Forty-eight of the patients were over 70 years old; in this group, the disease control rate was 60%, compared to a 67% rate in the younger group.  Time to disease progression was 7.2 months versus 7.5 months, and median survival was 10.7 versus 13.9 months for the older age group versus the younger age group, respectively.

Because these data were not significantly different, the treatment regimen was determined to be equally effective among elderly and younger mesothelioma patients.  These findings indicate that age should not restrict the use of the Alimta/Paraplatin combination in mesothelioma patients.

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