Releases Saturday 19 February 2000
No 7233 Volume 320
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(1) ALL YOUNG WOMEN WITH BREAST CANCER
SHOULD RECEIVE CHEMOTHERAPY
(2) OPTIMISTIC
PROGNOSES FOR TERMINALLY ILL
PATIENTS MAY
BE DETRIMENTAL TO THEIR CARE
(1) ALL YOUNG
WOMEN WITH BREAST CANCER
SHOULD RECEIVE CHEMOTHERAPY
(Factors influencing the effect of
age on prognosis in breast
cancer: population based study)
http://www.bmj.com/cgi/content/full/320/7233/474
All young women under the age of 35 years
with breast
cancer should be regarded as high risk
patients and be
offered chemotherapy after surgery (adjuvant
cytotoxic
treatment), say researchers from Denmark
in this week's
BMJ.
Dr Niels Kroman from the Danish Epidemiology
Science
Centre along with colleagues from Copenhagen
studied the
treatment and outcome of 10,356 women
with breast cancer
who were less than 50 years old at the
time of their diagnosis.
They found that overall, young women who
were diagnosed
with "low risk" breast cancers [as classified
by the authors]
and who did not receive adjuvant treatment,
had a
significantly increased risk of dying
as compared to
middle-aged women with "low risk" breast
cancer. The risk,
they report, increases the younger the
patients' age at
diagnosis (women under the age of 35 who
hadn't received
adjuvant treatment were more than twice
as likely to die as
women aged 45 to 49 years at diagnosis).
The authors say that the negative effect
of young age on a
woman's prognosis of breast cancer (a
phenomenon which
has been reported in previous studies)
seems to only be true
among those women who have not received
adjuvant
cytotoxic treatment. Among women who received
this
therapy, age did not have a significant
effect on prognosis,
say Kroman et al.
They say that their results cannot be taken
as direct evidence
that young patients with low risk disease
will benefit from
adjuvant cytotoxic treatment, however,
based on other recent
research they are confident that low risk
tumours will respond
well to such treatment, leading to a better
prognosis for this
group of women.
Kroman et al conclude that young women
with breast cancer,
on the basis of age alone, should be regarded
as high risk
patients and be given adjuvant cytotoxic
treatment.
Contact:
Professor Mads Melbye, Department of Epidemiology
Research, Danish Epidemiology Science
Centre, Statens
Serum Institut, Copenhagen, Denmark
Email: mme{at}ssi.dk
(2) OPTIMISTIC
PROGNOSES FOR TERMINALLY ILL
PATIENTS MAY BE DETRIMENTAL TO THEIR
CARE
(Extent and determinants of error
in doctors' prognoses in
terminally ill patients: prospective
cohort study)
http://www.bmj.com/cgi/content/full/320/7233/469
Many doctors inaccurately predict prognoses
for terminally ill
patients and most overestimate how long
patients will survive,
find researchers from Chicago in this
week's BMJ. This
overestimation is important because it
may lead to late
referral of patients for hospice care
and have implications for
the quality of their remaining life.
Professor Nicholas Christakis and Dr Elizabeth
Lamont from
the University of Chicago Medical Center
studied the
prognoses provided by 343 doctors for
468 terminally ill
patients (the prognoses were communicated
to the
researchers of the study and not the patients
themselves). Of
these prognoses, Christakis and Lamont
found that only
twenty per cent were accurate. Most predictions
of survival
(63 per cent) were overestimates and in
general these
overestimates suggested that patients
would live five times
longer than they actually did.
The authors say that their findings have
several implications.
Undue optimism about survival prospects
may contribute to
late referral for hospice care - patients
should ideally receive
hospice care for three months before death,
but they typically
receive only one month of care. They also
suggest that
doctors who do not realise how little
time is left for their
patient may miss the opportunity of improving
the quality of
their remaining life. Christakis and Lamont
report that a
patient's own conceptions of his/her future,
based on a
prognosis from his/her doctor is also
affected, and given an
optimistic outlook he/she may request
futile, aggressive care
rather than more beneficial palliative
care.
Doctors who have less personal attachment
to a patient tend
to make more accurate prognoses and more
experienced
doctors make less prognostic errors, say
the authors.
Therefore they suggest that "second opinions"
from a more
experienced, detached source may be valuable.
Christakis and Lamont conclude that the
bias towards
optimism in doctors' prognostic assessments
may be
adversely affecting patient care.
Contact:
Professor Nicholas Christakis, Department
of Medicine,
University of Chicago Medical Center,
Chicago
Email: nchrista{at}medicine.bsd.uchicago.edu
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(http://www.eurekalert.org)
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