world of cancer

Quality of patient life matters

June 5, 2015
Yet another post about news from the ASCO conference.

Sometimes treatment is worse than the disease, at least when it comes to whole-brain radiation, a new study declares.

Once cancer metastasizes (spreads) to the brain, doctors treat it with radiotherapy, which uses ionizing radiation to control or kill localized tumors. One-third to one-half of patients in the United States with these brain metastases—about 200,000 people—then receive whole-brain radiation every year. Typical side-effects include memory loss and other cognitive (mental) deficiencies.

Though the whole-brain radiation reduced recurrence of brain tumors in the study of 213 patients, it did not increase survival time. Wait, what?! That’s right: overall, patients who had only radiotherapy lived a median of 10.7 months compared with those who went through the extra step of whole-brain radiation, whose median overall survival was 7.5 months. (Please note that the differences in median survival are statistically moot, according to the Wall Street Journal.)

Paul Brown, professor of radiation oncology at the University of Texas MD Anderson Cancer Center, Houston, and lead author of the study, said, “The potential benefits of whole brain radiation therapy are far outweighed by the detriments of the therapy itself.” The “negative impact” on mental faculties “was more than I would have expected.”

The study included three-month follow-up tests of immediate recall of words, delayed recall, and measures of verbal communication as well as a quality of life questionnaire. The patients who received the radiotherapy and the whole-brain radiation scored lower on all tests and indicated a lower quality of life compared with those who only underwent radiotherapy.

That Dr. Brown and company conducted the study points to a change over time in thinking about how to treat brain tumors, in this example. As patients speak up more and more about the negative side-effects of cancer treatments, doctors are beginning to listen.

If you are having or have had cancer therapies and suffer from therapy-induced mental deficiencies, please tell your doctor. More reporting of these occurrences could lead to changes in protocols for future patients.

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