Statistical significance has very limited applicability to studies of patients with metastatic disease. A study result may be judged “statistically significant” if it is unlikely to have occurred by chance. However, the result may not mean much for the management of individual patients with metastases (Dean 1986; Fein 1986; Kassel 1974). The extent of the metastatic involvement, the severity of the debilitating effects on the patient, the speed of the metastatic process, the presence or absence of visceral metastases, and the patient’s Karnofsky (performance) status, in addition to many other factors, make the statistical evaluation of groups of patients of little practical significance. Complex emotional factors may also make the management of individual patients extremely difficult. The oncologist, the patient or the patient’s family often want “everything” to be done. Because of their perceived importance in the minds of many dying patients, oncologists themselves may sometimes indulge in magical thinking, searching for the miracle of “medicine X” which may be better than nothing (but not by much). Careful consideration of the critical trade-offs, which is so necessary in decision-making for patients with metastases, may be interpreted as therapeutic nihilism. Trade-offs between possible benefits of treatments and their price and between therapy-induced toxicity and the maintenance of normal life-style, are frequently muddled or forgotten, and this lack of clarity adds “costs” for everyone. For example, it is a common practice to employ antineoplastic chemotherapy when the anticipated response rate is 20%; usually survival is not prolonged, quality of life is not maintained, and the cost and time spent in the doctor’s office or hospital is excessive (Moertel 1991; Holli and Hakama 1991; Maher et al. 1990). Patients may also be irradiated again and again while ignoring evidence that radiations are ineffective (Maher et al. 1990; Maher 1991).
KeywordsToxicity Oncol Breccia Hypercal
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