Cancer chemotherapy--what have we achieved?

The outcome of referral to a medical oncology unit in a university teaching hospital has been determined for the first 500 patients seen in 1978. Their median age was 58 years, and half had been referred within 6 weeks of diagnosis. 316 had already received some form of treatment. Compared with the overall figures for New South Wales, there was an excess of lung cancer, breast cancer, head and neck cancer, ovarian carcinoma, and testicular cancer, but a smaller proportion of gastrointestinal cancers. No treatment was recommended for one-third. Of the 334 treated, 247 received cytotoxic drugs. By Aug. 1, 1979, 56% from the treated group and 52% of the untreated group had died, the median survival times for the two groups being 45 and 35 weeks, respectively. But, of the 50 who received "curative" or "adjuvant" chemotherapy, only 17 had died by Aug. 1, 1979. Serious complications of treatment occurred in 22 (8.8%) patients. The cytotoxic drugs used by the unit between January, 1978, and August, 1979, cost A$212 000 (9.3% of the hospital's total pharmacy budget for the period). The findings suggest that the widespread use of cancer chemotherapy is not justified outside well conducted clinical trials or specialist cancer centres.