Cancer treatment takes a harsh toll on the patient. Cancer therapies have potential side effects, some life-threatening. We must figure out what the right treatments are for each patient to maximize the therapeutic benefit and minimize unnecessary risks.
Since 1991, the National Breast Cancer Coalition has successfully advocated for increased federal funding for breast cancer research to answer those questions. We have also promoted a philosophy of evidence-based care among our members. We believe evidence-based care is patient-centered care.
Our success may have had costly unintended consequences. Gaps in our knowledge of cancer biology, therapies without a clear biologic target, perverse financial incentives, and patients' vulnerabilities have fueled a trend towards overtreatment of the disease. Research tests variations of escalating dose and schedule, and moves therapy earlier and earlier. To enable this “more is better” approach, supportive therapies – such as erythropoietin-stimulating agents, or ESAs – have emerged as a seemingly key aspect of breast cancer care. But to whose benefit?
Recently, serious concerns came to light about the safety of ESAs. Deaths from thrombosis[1] and tumor progression attributable to ESAs have been observed in clinical trials of advanced breast and other cancers. The first warnings emerged in 2004,[2] yet they were virtually ignored. Additional studies have been slow to come. At the same time, billions of dollars have gone to pay for these questionable therapies.
The patient community is alarmed. But what do our doctors say? The silence of the clinical oncology community on the dangers from the misuse of ESAs is deafening. Instead, oncologists have vehemently protested the decision by CMS,[3] in line with FDA warnings, to curtail the use of ESAs. This makes me question their priorities: Patients? Or profits?
That's my opinion. I'm Carolina Hinestrosa, breast cancer survivor and Executive Vice President at the National Breast Cancer Coalition.
Footnotes
Reader Comments on: A Question of Priorities in the Treatment of Breast Cancer See reader comments on this article and provide your own.
Readers are encouraged to respond to the author at chinestrosa@StopBreastCancer.org or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg@medscape.net
References
- 1.FDA. FDA strengthens safety information for erythropoiesis-stimulating agents (ESAs) March 9, 2007. Available at: http://www.fda.gov/bbs/topics/NEWS/2007/NEW01582.html Accessed April 8, 2008.
- 2.Pollack A. FDA wants more study on 2 drugs for anemia. May 5, 2005. Available at: http://query.nytimes.com/gst/fullpage.html?res=9506E4DF1E3DF936A35756C0A9629C8B63 Accessed April 8, 2008.
- 3.Hansen D. Survey: Patients harmed by anemia drug policy. Available at: http://www.ama-assn.org/amednews/2008/02/25/gvsb0225.htm Accessed April 8, 2008.
