The Statistics of Chemotherapy - May 7, 2014

I shall apologize in advance for not having the time to do exhaustive research on statistics.  Even so, the one simple example I present is generally representative of the problem.  I shall NOT apologize for my anti-chemotherapy bias.  I fully understand that having cancer (of any type) is a scary situation.  Doctors must recommend the accepted "standard of care" for your cancer or risk losing their malpractice insurance.  This is a big deal for both doctor and patient.  The problem is that the standard of care may not be the best choice in most cases.  But the "statistics" do indicate that dangerous treatments (chemotherapy, radiation, etc.) are effective in fighting cancer.  Given that fact, plus the fear factor, plus the calm and clear recommendation of a competent physician, it is nearly impossible for a rational person to choose to defer or refuse a treatment such as chemotherapy.  One is therefore left simply with a few choices between specific chemotherapy drugs and even fewer choices about the hardware and facilities in which they might be administered and followed.

How could I suggest that avoiding a statistically effective treatment is a better choice?  Let us examine the simple mathematics behind such statistics.  A friend of mine has a father who has just undergone major surgery for lung cancer.  His father is progressing well, and now the choice is whether to follow with one or more courses of chemo.  In this case, using some round figures, the doctor advised that the standard of care is to have a course of chemotherapy.  He also suggested the statistical edge is not very large, so there is an option available to go without it.  He is using the patient's advanced age and very good health to justify the deviation from the norm.  When pressed, he said that the chance of remaining cancer free is good - around 60%.  With chemo, the chance increases to 68%.  Seems like a no-brainer to choose the chemo, right?  Perhaps not.  Lets examine the numbers.

First we will postulate two sample groups, each consisting of 100 cancer patients.  The first group chooses NOT to have chemo.  The available data suggest that approximately 40 of those patients will have some type of recurrence of cancer, and this recurrence may not be the same type of cancer that they had before.  Even so, some of those 40 may be able to battle the cancer with surgery or other types of treatments.  Those that are detected earlier have better odds.  Some will not survive.  We do not have data on what might happen to those 40, but not all of them will die from cancer.  The bottom line is that 60/100 will not have a recurrence, representing 60%

The second group of 100 chooses to have one or more courses of chemo.  It is widely known that chemotherapy drugs are dangerous toxins requiring special handling by the medical providers and causing severe negative side effects in the patients.  These side effects increase dramatically with each successive dosage.  These toxic effects are part and parcel of the chemotherapy regimen.  The drugs are toxic to cancer cells, hopefully toxic enough to kill or weaken any tumors or microscopic (and undetectable) cancers.  Being this toxic to cancer also means the drugs are toxic (to some degree) to regular cells and bodily organs as well.  Patients who are strong enough to survive a systematic poisoning may well live healthy and cancer free lives afterwards.  What is not counted are those patients who are NOT strong enough to survive the chemo.  These unfortunate folks are simply removed from the sample.   The scenario therefore plays out like this:  100 patients take chemo.  Approximately 11 of those die from complications related to dealing with the chemo toxins, leaving 89 remaining.  of those 89, approximately 60 do not experience a recurrence of cancer.  The bottom line is that 60/89 will not have recurrence, representing 68%.

Do you see the problem?  60 of the first group had no recurrence and 60 of the second group had no recurrence.  But the second group was reduced in size by chemo-related mortality, so the % of those who had no recurrence seems 8% higher.  Is having the chemo really a no-brainer now?  (As an aside, nobody ever officially dies from chemotherapy, and few ever officially die from cancer.  Then nature of cancer and chemo are that the entire living system becomes overwhelmed, and those who are not strong enough experience a system shutdown.  Therefore cause of death is simply listed as "heart failure."  While technically correct, the term is misleading.)

Are the doctors and drug companies lying about the efficacy of chemo and other dangerous treatments?  Not technically, but the reality is the efficacy is certainly overstated due to the omission of ancillary mortality.  In the case of my friends, the doctor cannot recommend avoiding chemo and retain his insurance, but he can justify some weasel words.   He is probably not doing so because he does not "believe in" chemo.  More likely he wants to avoid making an elderly patient's life needlessly more miserable.  A noble, if misguided, goal.

If I were the patient, I would choose to avoid the chemo and emphasize healthy diet, alkalinity, and exercise.  It makes for a much more pleasant existence, and increases your real odds of survival (with or without cancer recurrence).  Thankfully bladder cancer provides me with two circumstances that enable me to do analysis and make informed decisions.  One is the luxury of time.  You don't usually have to rush into things, as BC is a bit slower killer than many other types of cancer.  The other is the existence of BCG biotherapy, a much less dangerous standard of care.  A recommendation for chemo and/or radiation is much more rare, providing additional time for study and consideration.

The reality is this - many of you or your loved ones will be overwhelmed and choose to do chemotherapy.  In order to be helpful, I reference the following resources, provided to me by a group that specializes in support for those who have chemo.  For those that choose to go this way, I wish you all the best.  I also hope you make you choice with your eyes wide open.

Other resources: