Talk:Chemotherapy

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Costs[edit]

I might be wrong but I think this article deserves a section on the costs of chemotherapy and issues in that field. Below are a couple interesting articles. The first one especially highlights how a treatment which costs 70,000$ in the US can cost much less in India... this is not due to a better service but due to the fact that there is no patent restricting the manufacture of the drug in India. I think if people were aware of specifics like this it might save many lives due to the fact that many who undergo chemotherapy purchase worse plans due to cost reasons or can only purchase until they are broke. I came to wikipedia to find a more organized and less biased account of chemo costs and the politics surrounding it and am sad there is no material. If this material exists somewhere on wikipedia I think it should be linked on this main page for chemotherapy. Finally, I cannot write this section myself as I am sure these citations I have linked are sub-par and someone with access to medical journals (especially a doctor in the field) could easily write up something very fruitful.

http://www.theatlantic.com/health/archive/2013/04/why-chemotherapy-that-costs-70-000-in-the-us-costs-2-500-in-india/274847/ http://www.livestrong.com/article/153376-the-average-cost-for-cancer-chemotherapy-treatment/ http://news.yahoo.com/sky-high-price-chemotherapy-why-cancer-drugs-cost-223821525.html — Preceding unsigned comment added by 178.222.9.12 (talk) 01:53, 2 June 2013 (UTC)

referenced[edit]

I have added lots of references and changed lots of the sections. If there are any problems with what I have done let me know and I/we can sort it out. There are still a few statements that are not referenced so I tagged them with citation needed. I have removed the following paragraph about differentiation and chemotherapy because I couldnt find any references for it, feel free to stick it back in if you can reference it.

"Drugs affect "younger" tumors (i.e., more differentiated) more effectively, because mechanisms regulating cell growth are usually still preserved. With succeeding generations of tumor cells, differentiation is typically lost, growth becomes less regulated, and tumors become less responsive to most chemotherapeutic agents. Near the center of some solid tumors, cell division has effectively ceased, making them insensitive to chemotherapy. Another problem with solid tumors is the fact that the chemotherapeutic agent often does not reach the core of the tumor. Solutions to this problem include radiation therapy (both brachytherapy and teletherapy) and surgery." Simon Caulton (talk) 08:29, 19 August 2013 (UTC)

There doesn't seem to be anything controversial in the above paragraph. As somebody with a master's in oncology, is there something there that you don't believe? We don't remove information from WP just because we don't have a reference, we add a [citation needed] tag. We remove only when the material looks fishy or is controversial, or is in a BLP. If you handled text otherwise, half of WP would disappear. SBHarris 19:48, 19 August 2013 (UTC)
Thanks for the reply. I do not necessarily have issue with the first part of the paragraph, although the only review article I could find only talked about differentiation and general prognosis/aggressiveness of the tumour. (Cancer cell differentiation heterogeneity and aggressive behavior in solid tumors pmid 22376239). However, the second part about radiation therapy and other treatments as a solution to chemotherapy not reaching the tumour core doesn't sound right to me. To my knowledge, the reason the chemotherapy cant reach the core is due to faulty vascular architecture, which is also the cause of hypoxia in these regions of cells. The problem is that radiation therapy needs oxygen to work and hypoxia is a major cause of radio-resistance in cancer cells. For this reason I am not convinced that saying that this is a solution to the problem is true. I think a statement like this definitely needs a quality reference to support it. However, I am open to the possibility I may be wrong... Simon Caulton (talk) 21:31, 19 August 2013 (UTC)
The first bit sounds maybe okay to me. The middle (division stopped) might be true, but it depends on the type of drug. For example, a drug interfering with mitochondria or ribosomes should do okay in that situation. The end seems like it might be "true, but"—one of those statements that is only true for a certain class of drugs and a certain 'idealized' situation—but even if it's true and verifiable, it feels backwards. Surgery is the first-line, most effective treatment for invasive solid tumors, and this makes it sound like a mere adjunct used to improve chemo's results if the tumor is too large or too poorly vascularized. WhatamIdoing (talk) 00:54, 20 August 2013 (UTC)
OK I have put in a bit about poor drug delivery due to poorly formed blood vessels, with a reference, into the limitations section. I haven't mentioned anything about solutions though. As for the first bit, I'm still looking for adequate references.Simon Caulton (talk) 08:20, 20 August 2013 (UTC)

Chemo doesnt work all of the time, after the five years usually heart and kidney disease occur[edit]

http://www.burtongoldberg.com/home/burtongoldberg/contribution-of-chemotherapy-to-five-year-survival-rate-morgan.pdf — Preceding unsigned comment added by 71.167.61.227 (talk) 14:17, 23 January 2014 (UTC)

The appropriateness of that paper for use in this article – and the serious concerns about the selection and interpretation of they data the authors chose to look at – came up on this talk page a couple of years ago; see Talk:Chemotherapy/Archive 1#Efficacy (2). The 'Efficacy' section of the current article emphasizes the point that cytotoxic chemotherapy is much more useful for some types of cancer than others, but it would be unwieldy to attempt to list all of the outcomes, for all chemotherapy regimens, for all cancers, within this summary article. We should definitely strive to include accurate and detailed information about the efficacy of chemotherapy for treatment of specific types of cancer where it will do our readers the most good: in the Wikipedia articles on those cancers. TenOfAllTrades(talk) 15:40, 23 January 2014 (UTC)

Table of agents[edit]

Fuse809 (talk · contribs) added a huge comprehensive table that summarises almost everything there is to know about chemotherapy.[1] Just a few questions:

  • Do we need to list monoclonal antibodies and other targeted therapy here? Technically it's not chemotherapy and this might need to be moved elsewhere.
  • Do we need references for the use of cladribine in multiple sclerosis? My feeling is that we should restrict ourselves to antineoplastic use.
  • Some columns are sourced entirely to three sources (Australian Medicines Compendium, BNF and Goodman & Gillman). Can we be certain that the information in these columns is verifiably present in all three sources?

Otherwise nothing but praise for this! Please make sure that it gets updated when new sources become available. JFW | T@lk 10:05, 28 February 2014 (UTC)

Firstly, it's not Australian Medicines Compendium, it's Australian Medicines Handbook. Secondly, I also used the reviews I referenced, I just giving them as general references. I was hoping that wiki would have an antineoplastic page, as it would be more applicable to this table, but apparently not. I listed other uses as most chemotherapeutics have more than just cancer as their uses. Plus I also listed other targeted agents in this table besides monoclonal antibodies. Fuse809 (talk) 10:10, 28 February 2014 (UTC)