Cancer Treatment Results  Survival Rates Cancer Treatments / Therapy Results
Cancer
 
Frequently Asked Questions

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?

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?

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?

The following cancers and grades are covered. Additional cancers are added periodically.

Brain Cancer
Anaplastic Astrocytoma (grade III)
Glioblastoma Multiforme (grade IV)
Breast Cancer
Advanced or Metastatic (newly diagnosed or recurrent)
Colon Cancer
Advanced or Metastatic (newly diagnosed or recurrent)
Kidney Cancer (Renal Cancer)
Advanced or Metastatic (newly diagnosed or recurrent)
Liver Cancer
Various
Lung Cancer
Non-Small Cell Lung Cancer (includes adenocarcinoma, squamous cell carcinoma, large cell carcinoma) - Advanced or Metastatic (newly diagnosed or recurrent)

Melanoma

Malignant
Mesothelioma
Malignant

Ovarian Cancer

Advanced or Metastatic (newly diagnosed or recurrent)

Prostate Cancer

Hormone refractory (advanced) or Metastatic (newly diagnosed or recurrent)
Rectal Cancer
Advanced or Metastatic (newly diagnosed or recurrent)

Are all types of treatments included in Cancer Monthly?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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.