chemotherapy doesn't improve quality of life or survival time in cancer patients

Think the latest chemo drugs help people to live longer or to have better quality of life? That would be nice.
You’d like to think that when your oncologist prescribes cancer drugs for your condition that there is some reason to believe that they will help you in any way: that they will help you to either live longer or live more comfortably. But several important recent studies have revealed that this hope is unfounded. Most new cancer drugs that are approved are approved even though they offer little, if any, real life benefit.

The first study looked at 62 new cancer drugs that were approved between 2003 and 2013 to see if any progress had been made: if they offered any additional benefit over the older drugs.

The findings were disappointing. Less than half of them—only 43%--increased survival time by more than 3 months. For 15%, the benefit was unknown; for 11%, the benefit was less than 3 months; and for a full 30% there was no increase in survival time over the old drugs at all. What’s worse is that even these improvements were sometimes based on indirect comparisons or unvalidated evidence, leading the researchers to concluded that “there may be reason to doubt that claims of efficacy reflect real-world effectiveness exactly”. Although 42% were associated with improved quality of life, 45% were associated with reduced patient safety (JAMA Oncol 2017;3(3):382-90.

A more recent study that asked the same question was even more discouraging. It concluded that “most [cancer] drugs entered the market without evidence of benefit on survival or quality of life.” This systematic evaluation looked at 48 cancer drugs that were approved for 68 indications between 2009 and 2013. Survival was significantly increased for only 35% of the indications. Overall survival improved by a median of only 2.7 months. If the drugs didn’t help you live longer but improved quality of life for the time you had left, a case could still be made for the drugs. But even this case is denied to conventional oncology. There was only improvement in quality of life for 10% of indications. When the drugs were followed for a median of 5.4 years, there was a significant improvement in either survival or quality of life in only 51% of them. For only 38% of the approved indications was there an increase in survival time. And when there was a benefit to survival time, that benefit was clinically meaningful only 48% of the time.

The researchers conclude that there is “no conclusive evidence that these drugs either extended or improved life for most cancer indications. When there were survival gains over existing treatment options or placebo, they were often marginal.”

The researchers of the second study also point out that claims of benefit are often based on indirect or “surrogate” measures of effectiveness (these may be studies that measure things like tumour shrinkage instead of survival time) that do not translate into improved survival time or quality of life. In fact, of the 68 indications discussed in the study, survival time was the primary endpoint studied in only 26% of them. Improvements in surrogate measures were the basis of drugs being approved for the other 69% of indications (BMJ 2017;359:j4530).

But a recent study found that, while most cancer drugs are approved based on these surrogate end points, in 86% of cases the improvement in surrogate end points, like tumour shrinkage, translate into either no gain or unknown gain in survival time. Only 5 of 36 drugs that improved surrogate end points actually improved survival time. 18 led to no improvement and 13 still had no reported survival benefit. The authors of this study concluded that most cancer drugs, though approved for benefit to surrogate end points, have not been shown to, or do not, improve clinically relevant end points (JAMA Intern Med 2015;175(12):1992-94).

These important recent studies have been published in leading medical journals. Together, they show that most chemotherapy drugs do not improve quality of life or meaningfully increase survival time. Most chemo drugs are not approved because they have been shown in double-blind studies to improve either of those two measures: the only two measures that matter. They have been approved because they improve some other measure, like tumour shrinkage, which, though it may sound good and give false hope to a desparate patient, has been shown to rarely lead to longer life. 

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The Natural Path is intended for educational purposes only and is in no way intended for self-diagnosis or self-treatment. For health problems, consult a qualified health practitioner for a comprehensive program.

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