At 16:26 23/10/98 GMT-2, Michael Power wrote:
>a colleague recently drew my attention to some interesting
>statistics: In the USA >70% of paediatric patients with cancer are
>entered into at least one clincal trial; only 2% of adults with
>cancer are entered into trials
I believe it to be true, but consider that this is a *proportion*, ignoring
the *absolute* numbers of patients entered on trial.
For example the recent overview of therapeutic trials in breast cancer
accrued +/- 100 000 patients into the metaanalysis. Most pediatric
malignancies are uncommon, so I suspect the total *number* of pediatric
patients ever entered on trial is less than this, although I do not have
the numbers to directly back up this assertion.
This is *not* to demean the excellent trial networks built up in ped. onc.;
they did have the option of totally ignoring trials etc! I cannot throw
light on why this did happen, but I suspect we need sociological type input
for that.
>
>internationally (in the developed world at least) most children with
>cancer are treated according to a defined protocol - And, systems
>exist to facilitate sharing experience.
>
This is an excellent standard; the small absolute numbers of patients
facilitate centralization which helps this process.
>In the past 25 years survival times and side-effects from treatment
>have improved dramatically for children with cancer (eg from 40% to
>70% cure rates) in contrast to minor improvements for adult with
>cancer even though there have been no new "frontline" therapeutic
>agents.
>
I dont think it is for want of trying things in the adult setting, nor is
it from lack of awareness of the advances the pediatric oncologists have
made.
>2) why have other specialities not followed the example of the
>paediatric oncologists
Excellent question; no answer.
As an aside I think that advances made in the pediatric field migrate into
routine practice faster than in the adult, again I feel likely to be
related to the smaller number of practitioners, the greater centralization,
the "culture" of the discipline etc etc.
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"You can't step in the same river twice." -- Heraclitus
"You can't even do it once." -- Heisenberg
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