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The Frequently Asked Questions (FAQ) below provide general information
about Cancer Monthly. Specific information about how to understand your
search results is covered in
How to Use Your Search Results Safely and Effectively.
| What is the purpose of Cancer
Monthly? |
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The purpose of Cancer Monthly is to help cancer patients get the facts
about the results of cancer treatments - both the successes and the failures
so that they can have productive discussions with their doctors. The information
is NOT intended, nor recommended as a substitute for professional medical
advice, treatment advice or treatment recommendations.
| How should I use the Cancer
Monthly information? |
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Cancer Monthly is a research aid for general informational purposes
only. The information is never intended to replace consultation with a
licensed healthcare provider. Instead, Cancer Monthly information
should be shared with your physician. (In fact, medical abstracts are
linked with each treatment for you to share with your doctor.) The Search
Results and Treatment Details contain only the highlights of
the clinical results of specific therapies, not every detail. Your doctors
can help you understand what a particular therapy means in treating your
cancer based on all of the facts regarding your condition and all
of the facts regarding that particular therapy. Please see How
to Use Your Search Results Safely and Effectively and the User
Agreement for more information on the appropriate use of this information.
| Which cancers are reported
in Cancer Monthly? |
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The following cancers and grades are covered. Additional cancers are
added periodically.
| Are all types of treatments
included in Cancer Monthly? |
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Yes. Orthodox or "conventional" therapies are well covered
in the medical literature so the results of chemotherapy, radiation therapy,
hormone therapy, and surgery are well represented. In addition, the newer
modalities such as biological therapy, immunotherapy and gene therapy
are also covered. Alternative therapies are also reported, but less frequently
because so few of them are actually tested. This lack of testing is due
to a lack of profitability and not a lack of potential efficacy (clinical
effectiveness).
Alternative therapies such as vitamins, herbs or amino acids are more
difficult to patent (because they are natural substances) and are therefore,
more difficult for pharmaceutical companies to own and control. Since
pricing is related to ownership (you can't set a price for something that
you do not control), alternative therapies are less profitable to drug
manufacturers. As a result of these economics, drug companies are less
inclined to invest research and development monies into alternative therapies
because their return on investment will be less compared to those treatments
that they can fully patent and own, such as chemotherapy.
How often is the Cancer Monthly
database updated
and how far back does the data go? |
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Every month, Cancer Monthly is updated with the results of cancer treatments
announced for that specific month. Cancer Monthly's database contains
the clinical results of reported treatments for the last 3-5 years depending
on the type of cancer.
| Does Cancer Monthly
cover the results of every study for a specific cancer? |
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No, Cancer Monthly does not cover the results of every clinical trial
or treatment. What is included, are the results for what Cancer Monthly
considers to be the most clearly reported clinical studies.
| What is the source of the
information? |
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The clinical results come from the medical and scientific literature
and announcements and abstracts presented at oncology meetings and oncological
symposiums. All of the source information is written by oncologists and
other doctors who treat cancer patients at leading hospitals and medical
centers in the U.S. and around the world. Cancer Monthly finds, organizes,
and summarizes the information published by the doctors who provided the
treatment. Cancer Monthly does not create any data whatsoever.
| Who calculated
the survival numbers? |
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The survival estimates for each individual treatment have been calculated
by the oncologists and other doctors responsible for administering that
specific therapy and publishing the results to the medical community.
If a treatment
has a median survival of 18 months and I receive
that treatment, does it mean that I will survive 18 months? |
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No, the survival numbers indicate statistical estimates (probabilities)
for the median survival for other patients who received that treatment.
The survival numbers should only be used as general information for three
reasons:
First, although oncologists who administered the treatment calculated
the survival number for the patients who received the treatment, the number
is based on statistical probabilities. This means that these are estimates
only.
Second, the numbers are usually median figures. This means that half
the patients were on one side of that number and half were on the other
side. The people on the far side of the line may survive for many years.
For example, if one patient lived 1 month, a second lived 2 months and
the third lived 18 months than the median survival would be 2 months.
The average (mean) survival, however, would be 7 months.
Third, these numbers cannot, and are not intended or designed to, predict
your specific prognosis. Every patient is different and your prognosis
will depend on your own unique combination of many variables including
your general state of health, age, diagnosis, cancer type and grade, whether
a cancer was completely removed by surgery (fully resectable), prior treatments,
and the extent of metastasis (if any).
Does my oncologist
know the outcomes (such as survival
and toxicity) for every treatment used in my cancer? |
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Treatment results are reported in many medical journal articles that
are published each month. Every oncologist may not be aware of everything
that has been reported this month in every medical journal or what treatments
are being used or tested in every hospital or country. The information
is gradually disseminated through symposiums and other professional meetings.
In addition, oncologists are often committed to using specific treatments
based on their training and experience, grants, patents, financial and
research interests, and relationships to pharmaceutical companies. Moreover,
a few oncologists compete to prove their treatment is best and will not
recommend a treatment being offered by another oncologist who they may
consider a "competitor."
Finally, an oncologist's perspective can be different from a patient's
perspective. Oncologists can afford to take a wait and see approach to
any new therapy that is unfamiliar to them. Patients, on the other hand,
are concerned with saving their life - now! When calculating the value
of a cancer therapy, the cost-benefit analysis that a patient performs
may be very different than the cost-benefit analysis performed by their
oncologist.
Does my hospital know
the outcomes (such as survival
and toxicity) for every treatment used in my cancer? |
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Cancer hospitals are only as good as their doctors and staff. Therefore,
the answer to the question above applies here too. In addition, cancer
hospitals often invest their personnel and financial resources in specific
treatments and are then inclined to have some of their patients become
enrolled in these therapies. For example, several years ago many hospitals
invested a great deal of money in building "clean rooms" in
their hematology-oncology departments. It was not surprising when these
same hospitals often recommended bone marrow transplants which require
the use of these rooms.
If there is a treatment
in another hospital, city or country
that I am interested in, do I need to go there to receive it? |
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Very frequently, more than one hospital is involved in the administration
of a treatment that is part of a clinical study or trial. To find out
if, when, and where a specific treatment is available, ask your doctor.
In addition, Cancer Monthly provides physician contacts for most treatments
so you can e-mail that doctor directly.
The search results usually
mention a Phase
I, II or III study, what does this mean? |
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Clinical studies that test new drugs, drug combinations and treatments
on people are divided into four basic phases - Phase I, II, III, or IV.
A Phase I trial or study is the first step in testing a new treatment
in humans. These studies test the best way to give a new treatment (for
example, by mouth, intravenous infusion, or injection) and the best dose.
The dose is usually increased a little at a time in order to find the
highest dose that does not cause significant side effects. As a result,
these studies often try to define a maximum tolerated dose. Therefore,
a Phase I treatment that originally resulted in a grade 4 toxicity (or
even 5), may be adjusted so that a lesser level of toxicity (i.e. 3 or
less) will result the next time it is used. In addition, because little
is known about the possible risks and benefits of the treatment, phase
I trials usually include only a small number of patients.
The purpose of a Phase II trial is to determine whether a new treatment
has an anticancer effect. Many oncological trials use "response"
as an outcome measure. A patient has a "response" when their
cancer shrinks (or there is an improvement in blood test results). It
is important to understand that there can be little or no relationship
between response and survival. Patients whose cancers responded to treatment
may survive no longer than the patient's whose cancers did not respond.
A Phase III trial compares the results of people taking a new treatment
with the results of people taking the standard treatment (for example,
which group has better survival rates or fewer side effects).
After a treatment has been approved and is being marketed, it may be
studied in a Phase IV trial to evaluate side effects that were not apparent
in the phase III trial.
| Are the results of some
clinical trials more reliable than others? |
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The reliability or "strength of evidence" of a clinical study
depends on two major variables 1) who performed the study; 2) the design
of the study.
In respect to who performed the study, investigator bias can play a role
in how the outcomes are reported. It is very difficult to determine if
and when there are real conflicts of interest. However, when an oncologist
receives compensation from a drug company and simultaneously authors a
study on that company's drugs, there is an apparent conflict of interest.
Cancer Monthly considers such facts to be relevant and provides information
on drug company support of individual studies when it is made available.
Note that there may be occasions when a drug company paid for a study
of its own drugs and such financial support is not disclosed.
In respect to the study design, there are various types. (These include
randomized controlled, double blinded or nonblinded, non-randomized controlled,
case series, consecutive - population based or not population based, and
nonconsecutive.) The randomized, double-blinded controlled clinical trial
is the gold standard of study design. However, in oncology very few treatments
can be designed this way because the procedures and toxic effects can
vary among study groups and both the doctor and patient need to be aware
of these. Therefore, most cancer trials are not blinded.
Finally, there are only a handful of studies that measure a treatment
against no treatment. For example, in some advanced and metastatic cancers
there may be little data to support the assumption that aggressively treated
patients live longer. Furthermore, there may be no data that treated patients
have a better quality of life than patients who decide not to be treated.
Unfortunately, such studies and comparisons are seldom performed.
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