Letters
Concerns about chemotherapy are legitimate
EDITOR,--Maurice L Slevin's editorial on adjuvant treatment in colorectal cancer reflects the prevailing conviction among oncologists about the beneficial effect of chemotherapy on survival in this disease.1 Unfortunately, Slevin probably overestimates the real effect because he selectively emphasises particular trials that have reported a survival benefit while ignoring other studies, testing identical regimens, in which no benefit was apparent (N Wilking, Stockholm colorectal cancer symposium, Stockholm, 12-13 Oct 1995).2 3 Moreover, even in those trials cited, the reported improvements in survival are only moderate, the confidence limits are wide, and the apparent effect is restricted to patients with positive nodes (type C disease).
The proportional reductions in the risk of dying, as used by Slevin, give a misleadingly optimistic view of the benefits in terms of absolute survival. It is more appropriate here to use the "number needed to treat" method.4 In the non-adjuvant "therapeutic desert" referred to by Slevin 100
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- Adjuvant treatment for colorectal cancer
- Maurice L Slevin
BMJ 1996 312: 392-393.[Extract] [Full Text]
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