The Chemotherapy Shortage: should we be worried?

Jacob Schor ND, FABNO

August 25, 2011

 

 

We’ve been hearing and reading about a shortage of chemotherapy drugs nationwide for months now but it was only last week that we saw patients switched from standard of care drug protocols to secondary protocols.  A recent Op-Ed piece written by Ezekiel Emanuel appeared in the Sunday New York Times two weeks ago and is worth reading if this situation is of concern to you or a family member.   Dr. Emanuel does a decent job of explaining the financial disincentives that have led to this fiasco.

 

 

http://www.nytimes.com/2011/08/07/opinion/sunday/ezekiel-emanuel-cancer-patients.html?_r=1&scp=2&sq=chemotherapy%20shortage&st=cse

 

How serious a problem is this going to be?  Will we see a spike in cancer deaths in the mortality statistics as a result?  Probably not.

 

We all tend to perpetuate a belief that chemotherapy is much more effective in treating cancer than it actually is. While many practitioners are forever optimistic that the right mix of chemotherapy will yet improve cancer survival, the data does not in general support their optimism.

 

Chemotherapy rarely works as well as we would wish it to.  For the majority of cancers chemotherapy makes little difference. Five-year survival rates change far less then one would guess. 

 

An overview published in 2004 in Clinical Oncology entitled, “the Contribution of Cytotoxic Chemotherapy to 5-year Survival in Adult Malignancies” lays out exactly how pitiful a situation this really is. [1]

 

The authors, all from Sydney, Australia, compiled all the randomized clinical trials that report 5-year survival benefits that result solely from cytotoxic chemotherapy.  They calculated data for 22 malignancies on the increased survival that results from chemo.  Their conclusion:

 

“The overall contribution of curative and adjuvant chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA.”

 

 

Percentage 5-year survivors due to chemotherapy

Cancer Type Australia United States
Head and neck 2.5% 1.9%
Esophagus 4.8% 4.9%
Stomach 0.7% 0/7%
Colon 1.8% 1.0%
Rectum 5.4% 1.4%
Lung 1.5% 2.0%
Melanoma 1.5% 1.4%
Cervix 12% 12%
Ovary 8.7% 8.9%
Testicular 41.8% 37.7%
Brain 4.9% 3.7%
Non-Hodgekin's Lymphoma 10.5% 10.5%
Hodgkin's disease 35.8% 40.3%
     

 

 

Thus in general for the majority of cancers whether or not a patient receives any chemotherapy at all makes only a small difference in long term survival, whether or not a patient receives the first choice drug or not will probably make such a small difference as to be barely detected.  So in general there is little cause for worry unless you have one of the few cancers such as Hodgkin’s disease in which chemotherapy can potentially make a large change in survival.

 

Reference:

 

 

1. Clinical Oncology (2004) 16: 549-560

Clinical Oncology (2004) 16: 549-560