Reducing the cancer bill.

Thomas Smith and Bruce Hillner from Virginia Commonwealth University have developed a scheme for making cancer treatment cheaper. Their program involves the following:

1] Abandoning regular scheduled surveillance testing with serum tumor markers and imaging for most cancers,especially for pancreas, ovary or lung because such screening does not alter prognosis - (We don't do it this side of the pond anyway)

2] Cancer drugs should be sequential monotherapy rather than as combined treatment, because combination treatment offers few benefits, is more expensive, and causes more toxicity - (this is not true for hematological cancers and has been clinical trial driven. Sometimes we reduce the number of drugs, eg FR seems to be just as suitable as FCR for mutated CLL)

3] The decision to offer chemotherapy to advanced metastatic cancer should depend on the patient's performance status. As a general rule patients should be able to walk unaided into the clinic to receive chemotherapy - (Again this may not be true for rapidly progressive hematological cancers, which can be reversed just as rapidly. But for solid tumors this would be the rule in the NHS.)

4] Hematopoietic growth factors should be avoided or lower doses used. Although they stimulate white cell growth after chemotherapy they do not improve survival in either lymphoma or small cell lung cancer - (I agree with this one. We use too many growth factors)

5] Patients with progressive disease should be switched to palliative care after three consecutive regimens of chemotherapy because the chances of success are minimal with subsequent courses - (again this is very true and too much futile chemotherapy only inflicts harm on patients.)