Q: IF metastatic cancer is incurable and chemotherapy only prolongs survival by a few months, why should patients agree to have it?

A: Each patient with cancer, whether metastatic or localised, is an individual. As I explained in my article, the results of clinical trials that confirm the superiority of chemotherapy over best supportive care (or no chemotherapy) of the order of three to four months is a guide to help oncologists in deciding whether to offer patients treatment.

It is a statistical measurement and not a prediction of survival for an individual patient. A good analogy is the time it takes to travel by car from KL to Johor Bahru. On average, it takes about four hours provided there is no trouble on the roads and one drives within the speed limit. In reality, it can take more or less time, depending on the circumstances. The same applies to a patient?s survival undergoing chemotherapy.

Furthermore, these trials were conducted many years ago using older drugs. Most cancer research trials today would not compare the new chemotherapy drug with best supportive care as this would be considered unethical as patients should be offered the standard treatment at that time.

Many of the newer drugs used now were shown to be better than the older drugs used to confirm the advantage of chemotherapy over best supportive care.

In addition, there are many papers published in cancer journals that confirm the improvement in quality of life among patients who receive chemotherapy compared to those who do not. This is because cancer causes symptoms and these symptoms worsen or new symptoms appear if the cancer progresses.

Chemotherapy is able to arrest the growth of cancer and even shrink the disease thus reducing the cancer load and improving the patient?s cancer symptoms. This in itself may be worthwhile if the side-effects of the chemotherapy can be managed well as it will allow the patient to get on with his life and spend quality time with his or her family

Is the dose of chemotherapy drugs used the same for all patients with metastatic breast cancer?

Chemotherapy regimens have standard drug doses. This is determined by clinical trials so that the drug will deliver the desired effect at a tolerable level of toxicity. A particular patient will have a dose calculated according to her height and weight. However, this may be, and is often, modified to suit the patient. The dose of the chemotherapy drug is altered to take into account the patient?s fitness, kidney and liver function.

There is often a choice of chemotherapy drugs and regimens that can be used in metastatic breast cancer and the decision as to which to use is done after discussion between the patient and the oncologist.

The decision may be an entirely prosaic one, such as the distance between the patient?s home and the cancer centre. A visit once every three weeks may be the preferred option if the patient lives far from the cancer centre or has transport problems.

Other options may involve weekly visits for intravenous chemotherapy or oral chemotherapy.

For more FAQs, please visit www.malaysiaoncology.org