Models for weighing benefits and toxicities
Toxic effects of antineoplastic treatments represent a major consideration for every decision making process for both the patient and the physician. This is true for either the curative or the palliative disease settings. Palliative intent requires taking into account the side effects of treatment, especially those of a subjective nature. Outside the clinical-trial setting, use of the least toxic treatment approach to achieve a decent palliation is recommended medical practice. On the other hand, for patients who have operable disease and thus are potentially curable, reducing the incidence of relapse is the primary objective of the therapeutic approach. Lesser emphasis is placed on aspects of quality of life and subjective toxic effects of treatment. Similar considerations apply for diseases such as acute leukemias, lymphomas, and metastatic testicular cancer, in which the chances of long-term survival are almost exclusively dependent upon effective cytotoxic treatments. In diseases such as operable breast cancer, for which adjuvant cytotoxic and endocrine therapies have demonstrated a modest but statistically significant reduction in mortality , subjective toxic effects of treatment represent an important component in the decision making process. Much of the progress made in the treatment of this disease is attributed to the clinical trials approach in which survival, disease free survival, response rates, remission induction rate, time to progression, and incidence of toxicities are prospectively recorded as the principal endpoints.
KeywordsBreast Cancer Clin Oncol Operable Breast Cancer Systemic Relapse Utility Coefficient
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