Talk:Chemotherapy/Archive 1

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Definition

I was taught that chemotherapy is the use of synthetic agents to selectively injure particular organisms or cells within a patient. This includes anticancer, antibacterial, antiviral, anti-fungal and anti-protozoal chemotherapy. Natural and semi-synthetic antibiotics are not included in a strict definition because they are natural compounds. The sulfonamides are synthetic "antibiotics" are so are true chemotherapeutic agents. I don't know about the natural-source anticancer drugs (vinca alkaloids and all that). The lay public thinks CHEMO = CANCER; I think it would be worth changing the slant of this article. Anyone else? ben 13:12, 23 June 2006 (UTC)

Probably the more recent "questionable" usage is so widespread that it eclipses the "proper" usage. This problem occurs elsewhere; i.e. begging the question. I think that a note about the etymology (that "chemo" means chemical and "chemotherapy" originally meant therapies using synthetic chemicals) might be appropriate, but a citation of that usage would be nice (a la the OED), and it may be hard to find a text online with that usage. MartinGugino 00:38, 6 August 2006 (UTC)


The modern definition of chemotherapy (according to the OED) :

"The treatment of disease, esp. of parasitic infections or cancer, by means of chemical substances which act selectively on micro-organisms or malignant tissue."

The term was coined by Ehrlich, and it referred to the killing of (bacterial, protozoan, etc) cells by means of chemicals (as opposed to by serum (antibodies), etc.). Later, the term was also applied to cancer cells, and there are a lot of similarities between the two. I frequently hear antibiotics today referred to as chemotherapy, and I think this article should be moved to an article called "Cancer chemotherapy", and a new generic chemotherapy article should be implemented that discusses the similarities of the two, and points to both. This is analogous to the word "steroid"...the popular definition means "anabolic steroid", but properly it is a more generic term, and the Wikipedia article reflects this. Similarly, the popular definition of "chemotherapy" refers to "cancer chemotherapy", but Wikipedia doesn't yet reflect this. Mauvila (talk) 00:52, 13 December 2007 (UTC)

Considering that some of the most promising anti-cancer agents are antibody-driven, perhaps this article should follow the WHO convention and be renamed to "antineoplastic agents", with "chemotherapy" serving as a disambiguation. --Arcadian (talk) 13:49, 13 December 2007 (UTC)
Not sure if the Ab would be considered chemo or not...I think the distinction between chemo and bio becomes trivial at some point thanks to modern molecular engineering. "Anti-neoplastic agents" seems a little overkill...plus, the term agents will open the door to all sorts of herbal and junk remedies...chemotherapy still strongly implies the killing of cells, a quality which agents doesn't necessarily emphasize. Mauvila (talk) 18:13, 4 January 2008 (UTC)

Side-effects

Current chemotherapeutic techniques can have a range of side effects mainly affecting the fast-dividing cells of the body. These include the mouth, digestive system, skin, hair and bone marrow.
Most frequent and most important side-effects of chemotherapy :

  • hair loss
  • fatigue
  • vomiting
  • wight loss or gain
  • anaemia
  • depression of immunity hence infections
  • hemorrhage
  • secondary neoplasms
  • cardiotoxicity
  • hepatotoxicity
  • nephrotoxicity

[1] [2] [3] [4][5] [6] [7] [8]

[9]

[10]--86.29.247.206 (talk) 19:11, 2 June 2008 (UTC) [11] [12] [13]

--Chemo facts (talk) 13:51, 3 June 2008 (UTC)



The treatment can be exhausting physically for the patient.
Sometimes the complete myelosupression is the intended treatment that is in these cases followed by allogenic or autogenic stem cells transplant.

However some patients still develop diseases such as fungal tuberculosis because of this interference with bone marrow.

Isn't "fungal tuberculosis" a misnomer ?
I agree; tuberculosis isn't fungal. ben 13:06, 23 June 2006 (UTC)
agreed. Buzybeez 15:25, 12 July 2007 (UTC)

What about the physiological causes of the side effects, especially the depression of immune system? I heard vomiting is due to destruction of stomach lining Animation about side effects of chemo The animation is a commercial for a drug but has lots of useful info. Karl.langberg (talk) 17:46, 24 April 2008 (UTC)

That is not a typical reliable source. There are numerous causes to CINV, and mucositis is only one of them. JFW | T@lk 22:26, 24 April 2008 (UTC)

"Mutations of normal cells creates cancerous tumours which can grow out of control."

Be careful, because most mutations to genetic information in cells will actually kill it. It is only in the relative minority of cases where a mutation will actually cause a cancer.

Jedi Dan 16:29 Apr 23, 2003 (UTC)

Chemo is deadly

Both my mother and father were killed by chemo.--Mr-Natural-Health 21:42, 7 Dec 2003 (UTC) (on talk:Alternative medicine)

It is sad that you lost both of your parents Mr-NH. It is a private event that sensitive people would usually refrain from referring to, but your comment raises points that really need addressing. Do the death certificates state that chemotherapy caused the deaths of your parents? As you are such a strong advocate for alternative medicine, could you not convince them to try that? Had they been exclusively using alternative medicine and had still died would you have written here "by the way, both my mother and father were killed by alternative medicine?" Moriori 22:15, Dec 7, 2003 (UTC)
Mr-Natural-Health is nuts if he believes that doctors killed his parents by trying to save their lives with chemotherapy. Apparently (if we are to take his word), his parents were killed by cancer, but at that point his [personal attack removed], so he decided to blame doctors. RK
That is tantamount to saying that the Doctors who treated George Washington in 1799 with repeated bleedings and dosages of calomel did not kill this founding Father of the United States. Following RK's logic, our president died from old age. What I call Quackery, is the science community conveniently leaving out the little detail that Chemo comes with a minor side effect called death.--Mr-Natural-Health 13:48, 13 Dec 2003 (UTC)
You may be right, but I'd prefer to hear what Mr-NH has to say. Moriori 01:30, Dec 8, 2003 (UTC)
Ha, ...Hah, Ha! I finally found this article on Chemotherapy and just now have discovered that my comments have arrived before me! Yes, Chemo is truly the heroic medicine of the modern era.--Mr-Natural-Health 12:52, 13 Dec 2003 (UTC)

I'm pretty sure that chemotherapy can be lethal, and that this is undisputed, rather than a sign of someone being nuts. For example, it reduces the immune system, so the patient may contract a fatal disease in their weakened state, be unable to fight it off, and subsequently die. That's why people undergoing chemotherapy are carefully monitored. In a few cases, chemotherapy may kill someone before their cancer would have done, had it been untreated. Chemotherapy is used because it helps more often than it causes harm, but it is not without side effects, and those side effects are potentially lethal. Martin 00:11, 9 Dec 2003 (UTC)

Quite right. Chemo causes substantial damage to the vascular system and many people later get cardio-vascular disease. Many of Mr NH's points were not frivolous. -- Viajero 00:15, 9 Dec 2003 (UTC)

I think this issue is hardly worth discussing. It is so obvious that chemotherapy although not without downsides is an important treatment modality. Eventually it will (hopefully) be replaced by better methods of fighting and preventing cancer but for the time being that's a tool that definitely has a place in cancer management. Period.

BTW antibiotic therapy can rarely cause fatal side-effects and chemotherapy can prolong life and properly used can cause less damage that the disease itself. So is antibiotic therapy to be abolished ?

Kpjas 16:18, 13 Dec 2003 (UTC)

I have a friend who got 3 years of Chemotherapy in just 6 months, she was also told that her life was gonna be shorter (50 to be exact, she's 23 at the time) clearly this is caused by this "overdose" and may infact cause death.
And this is why i have added death/shorter life as a side effect and is pretty much correct. But yes everything in a overdose can cause death but this is a medecine. Slushq 08:34, 11 June 2006 (UTC)

Overdosing is deadly of course and so is inappropriate drug delivery. I find it very interesting that people have not found any alternative drug delivery methods that have better cytotoxicity regarding the tumor and not the patient, such as http://en.wikipedia.org/wiki/Electrochemotherapy

Owners of pharmaceutical companies probably know the answer.. :) —Preceding unsigned comment added by 212.93.227.10 (talk) 15:30, 31 March 2008 (UTC)

Source for your allegations? Or is it just that all evil in the world is being perpetuated by big pharma? JFW | T@lk 15:59, 1 April 2008 (UTC)
Everybody knows that already? Just kiddin. I am gaining a little experience in pharma business at the moment (operating as a CRO) and sadly I dont like what I see.. —Preceding unsigned comment added by Leskovsek (talkcontribs) 21:52, 2 April 2008 (UTC)
Neither anaemia nor obesity are typical causes of death. Rather than posting vague messages here, you might want to clarify with the doctor in question whether the chemo is to blame. Obesity is not a typical complication of chemo. JFW | T@lk 17:10, 5 May 2008 (UTC)

Death, and Some other Notes.

Of course chemotherapy, can cause death. Why would chemicals not be able to kill you?

Shouldn't the story of Abraham Cherrix be added? Abraham is a 16 year old teen that has cancer and the court tried to force him into taking Chemotherapy.

Shouldn't there be something about criticism? There is a lot of criticism againsto chemo, and if it is a multi billion dollar industry there should be a lot of criticism against it.

Like is it being used just to make money?

I very strongly agree there should be a discussion of the negative issues associated with Chemo for instance this from USA Today should be added:

Study: Chemotherapy can alter brain by killing cells Posted 11/29/2006 9:07 PM ET http://www.usatoday.com/news/health/...py-brain_x.htm

[Copy of entire article removed JFW | T@lk 23:16, 21 October 2007 (UTC)]

Also see- Post-chemotherapy cognitive impairment!--86.25.48.119 (talk) 15:14, 17 August 2008 (UTC)

Leah's death

My sister, Leah, (41) took a 10 month's chemo due to Brest cancer, and suffered badly. She soon went bald after a week or so, then became constipated, became very smelly after 2 months and at about the same time her weight rapidly rose from 9st 2lb to 13st 6lb, after the 7th month due to water retention. She finally died of a heart attack the doctor was convinced was caused by here body weight problem. She also had trouble with anemia at this point. Her chemo would have only lasted for just over 3 more months and it would have been over. Chemo can kill with anemia and obesity in some cases! --86.29.255.225 01:19, 29 July 2007 (UTC) --86.29.251.5 (talk) 14:02, 5 June 2008 (UTC) --86.29.241.138 (talk) 19:18, 25 July 2008 (UTC)

Please refrain from listing off-topic anecdotes like this one (and in the previous section). If you're interested in improving the article, please only propose content that could potentially be sourced by reliable sources. Anecdotes by editors that are not listed in a reliable source are off-topic and can be removed at any time. ~a (usertalkcontribs) 20:19, 25 July 2008 (UTC)

As for Post-chemotherapy cognitive impairment syndrome.--86.25.48.119 (talk) 15:12, 17 August 2008 (UTC)

Splitting types?

Anybody object if I split the sections in "Types and dosage" onto their own subpages? --Arcadian 03:18, 23 November 2005 (UTC)

I don't know; the chemotherapy article as it stands isn't overly long—in total it still is less than 32 KB. If you're planning on expanding those sections significantly, then it might be appropriate to split it into a sub-article. (I could also see a benefit to giving parts of the article a good copy-edit, but I haven't got the time right now....) TenOfAllTrades(talk) 04:03, 23 November 2005 (UTC)

We should minimally have alkylating agent and anthracycline, two major classes. I'm not convinced we need to have specific pages for the vinca alkaloids, the topoisomerase inhibitors etc. JFW | T@lk 08:47, 23 November 2005 (UTC)

Since we do already have pages for alkylating agent (and individual pages for a number of specific drugs) we could probably condense the section in this article a bit—describe the mechanism briefly and add a See main article: alkylating agent pointer. TenOfAllTrades(talk) 15:44, 23 November 2005 (UTC)
Okay, I chose the middle path -- I split out Alkylating agent, Antimetabolite, and Antineoplastic, because they already had existing pages, and some of the content on those pages had been gradually diverging from the content on this page. The other categories I left in. --Arcadian 18:58, 27 November 2005 (UTC)

Safety

The page needs a section on safe handling of chemotherapeutic agents. Handling applies to healthcare providers, the patient, and the patient's household members. See for example [Safe handling of hazardous drugs]. 66.167.45.138 15:31, 30 January 2007 (UTC)

And extravasation. JFW | T@lk 23:16, 21 October 2007 (UTC)

Delivery

The article does not mention localised methods of delivery, targeted at the cancer itself. Any news.

It does now. JFW | T@lk 23:16, 21 October 2007 (UTC)

Re : Delivery

I've added some brief sections on isolated infusion approaches, stem cell harvesting and autologous bone marrow transplant, and on minicells. I've also discussed the importance of these approaches since severe toxicity is the limiting constraint on dosage and effectiveness of traditional systemic chemotheraputic approaches.

I hope that this helps. (Naturally, please add to, modify and/or improve these changes.) Regards, G. Holt

Mr(?) Holt--please sign your posts using the tool on your wikipedia editor. Also, I edited your statement above. Also, I am continuing to redact your minicell section.

Uh, pot-kettle phenomenon on signing here. The new approaches are useful, but are the minicells being used in practice? If not, they should not be mentioned. JFW | T@lk 23:16, 21 October 2007 (UTC)

Minicells

Someone keeps expanding the minicell section; I will continue to shorten it. This is not a mainstream approach; this article is called "chemotherapy," not "chemotherapy research," so we should limit the experimental info on it.--Dr.michael.benjamin 05:19, 29 June 2007 (UTC)

I agree. There are many other delivery systems under development. JFW | T@lk 23:16, 21 October 2007 (UTC)

Does chemotherapy work?

This article and most online information starts from the assumption that chemotherapy works. There are also a number of pages saying that it doesn't work or that the medical profession has no evidence that it works. Some people even believe that big Pharma pushes these drugs to make money. I think its important to add a section summarizing the evidence that chemotherapy actually works. I can write it if someone has the references. Dr d12 03:31, 19 August 2007 (UTC)

Do antibiotics work? Depends which infection and which antibiotic. We cannot possibly enumerate all the trials that show the efficacy of chemotherapy in specific cancers. That should remain on individual disease pages, e.g. lung cancer should discuss the platinum/topoisomerase inhibitor combinations used commonly nowadays.
Beware that "big Pharma" is a "word to avoid" in these discussions. It suggests corporations are acting unethically, a subject of which we can not generalise. JFW | T@lk 23:16, 21 October 2007 (UTC)

chemotherapy cost

What are the costs of a chemotherapy for an hospital, and more generally, from a Welfare-State point of view ? 82.240.207.81 13:33, 23 September 2007 (UTC)

Some are cheap, and some are expensive (e.g. cyclophosphamide is 100x cheaper than paclitaxel according to a 2000 estimate - Bodurka-Bevers D, Sun CC, Gershenson DM (2000). "Pharmacoeconomic considerations in treating ovarian cancer". PharmacoEconomics 17 (2): 133–50. PMID 10947337. ). Modern targeted therapies are often very expensive. JFW | T@lk 23:16, 21 October 2007 (UTC)

inconsistency

The article initially states that the active compounds from the american mayapple work by an unknown mechanism, then under topoisomerase inhibitors it is claimed they are type II topoisomerase inhibitors... which is it? 207.108.208.213 03:18, 13 November 2007 (UTC)B. Simon


Exsperimental Radar teatment

It's a new treatment that is being pioneared in the U.S.A. and U.K. [[9]] —Preceding unsigned comment added by 86.29.244.128 (talk) 18:14, 28 November 2007 (UTC)

Electrochemotherapy paragraph in Chemotherapy page?

Hi everyone, I have written an article about electrochemotherapy here: http://en.wikipedia.org/wiki/Electrochemotherapy and I am trying to introduce links in articles on related topics (following the message at the beginning on article "This article is orphaned as few or no other articles link to it.Please help introduce links in articles on related topics. (January 2008)").

I believe it would be fairly appropriate to include the short paragraph in the 'cancer page', as I can not find any other article as related as this one. You can read more about ECT at the http://en.wikipedia.org/wiki/Electrochemotherapy and help me with providing some feedback about what to include in the paragraph.

Thank you, Matevz Leskovsek —Preceding unsigned comment added by Leskovsek (talkcontribs) 08:40, 6 March 2008 (UTC)

Would this paragraph ba appropriate as the following:

Electrochemotherapy is a therapeutic approach providing delivery into cell interior of nonpermeant drugs with intracellular targets. It is based on the local application of short and intense electric pulses that transiently permeabilize cell membrane, thus allowing transport of molecules otherwise not permitted by a cellular membrane. Presently, applications for cancer treatment have reached clinical use (antitumor electrochemotherapy using bleomycin or cisplatin). Electrochemotherapy with bleomycin has been used to treat the patient for the first time in 1990 at the Institute Gustave Roussy in France, while electrochemotherapy with cisplatin has been used to treat the patient for the first time in 1994 at the Institute of Oncology, Ljubljana, Slovenia. Since then more than 600 patients were treated with electrochemotherapy all over the world (Australia, Austria, Denmark, France, Hungary, Ireland, Italy, Japan, Mexico, Nicaragua, Portugal, Slovenia, Spain, Sweden, UK, USA).

Please, reply with some feedback (regarding the paragraph to include or regarding the whole ECT article).. I am not a doctor myself, I am a PHD student in the field of biomedical engineering working mainly on ECT.

Best regards, Matevz —Preceding unsigned comment added by Leskovsek (talkcontribs) 09:57, 10 March 2008 (UTC)

I have added the above paragraph, please post any comments for discussion —Preceding unsigned comment added by Leskovsek (talkcontribs) 17:45, 17 March 2008 (UTC)

I completely disagree. 600 patients is child's play considering there are millions of people having cancer treatment worldwide at any given time. It is not standard treatment for anything, and I strongly oppose mention of this modality until there is data that this works and works well, and becomes part of the arsenal of oncologists worldwide. Who says intense electric pulses make cell membranes permeable? Surely that would give interesting pictures on MRI scans? JFW | T@lk 20:02, 17 March 2008 (UTC)

IMO, it belongs on Unproven cancer therapy. WhatamIdoing (talk) 22:08, 17 March 2008 (UTC)
Dear doctors! If you happen to disagree with the article: http://en.wikipedia.org/wiki/Electrochemotherapy - I'll have to ask you to repair/edit it yourself or adress your issues on its dedicated talk page. I will also have to ask you NOT to express your feelings by not allowing to introduce links from other relevant articles, such as Wiki:Cancer.

I am currently reading the wiki guidelines and see no excuses for your behaviour. I understand the responsibility that you feel towards the "Cancer" article but I will have to ask you to reconsider the above inclusion.

For Gods sake, please read the article first: http://en.wikipedia.org/wiki/Electrochemotherapy —Preceding unsigned comment added by Leskovsek (talkcontribs) 16:02, 18 March 2008 (UTC)

immunosuppression and stem cell transplants

hi all,

i added a little bit of information about allogeneic and autologous transplants below the paragraph that had lots of wrong information. i dont really care to make a pretty paragraph with in depth information but below it i typed up some general sloppy information...at least all of it is correct. the paragraph above shows that the writer has no idea what transplants are actually used for..well the effort that i put into fixing that section was erased...that's lovely, just know that the information in the article regarding transplants is completely wrong

If you contest something, use the {{fact}} or {{dubious}} tags, but we can't have un-cited, grammatically unprofessional sentences (starting a sentence with lowercase, etc., as you did above — it's fine here, not in the article). Thx in advance. El_C 05:33, 8 March 2008 (UTC)
eh, i dont care enough to go through all that trouble, just know that the guy who wrote that paragraph has no idea of the purpose behind a transplant. its spelled allogeneic, not allogenic... —Preceding unsigned comment added by 69.138.161.23 (talk) 05:45, 8 March 2008 (UTC)
Okay, I don't know what that is. El_C 05:56, 8 March 2008 (UTC)

Stem cell transplants are only of any use in myelo- and lymphoproliferative diseases, and then only as an adjuvant after high-dose chemotherapy (although some graft-versus-disease effect is also expected). Most actual cancers are not treated with HSCT, and in breast cancer we have reasonably good data that it is of proven uselessness. JFW | T@lk 19:58, 17 March 2008 (UTC)

Usefull links

--86.29.246.126 (talk) 11:07, 2 June 2008 (UTC)

--86.29.242.198 (talk) 15:34, 23 November 2008 (UTC)

Electrochemotherapy

I think this page on Electrochemotherapy might be of relivence to. Merge it?--Amama z. Suliman (talk) 19:08, 17 August 2008 (UTC)

Is a targeted therapy a chemotherapy

Do we agree that in common usage targeted therapy is not chemotherapy - and hence most antibody based therapy should be in targeted therapy instead ? Rod57 (talk) 14:58, 15 November 2008 (UTC)

prodrug

The prodrug pages says many chemotherapies are prodrugs which are preferentially activated in hypoxic cancer cells (reducing side effects) - but there is no mention of prodrug here. Could we list which are prodrugs ? Rod57 (talk) 17:51, 30 November 2008 (UTC)

Moved

Why was this moved to (oncology) in the first place? There is really no need for disambig pages for things like this, and it just messes up the layout of the site. IMO it's best to have it moved back by an admin. 75.79.59.93 (talk) 06:06, 26 January 2009 (UTC)

Efficacy

About this sweeping claim of inefficacy: The study is out of date (17 years old!), and seems unfairly misrepresented here. "Chemotherapy doesn't help most kinds of advanced epithelial cancers" is rather different from "Chemotherapy cannot extend in any appreciable way the lives of patients".

For one thing, an enormous number of people receiving chemo don't have advanced cases; for another, small-cell lung cancer probably is "common", and yet the evidence for efficacy is fairly strong there.

It would be nice, I think, to have some information about the relative usefulness of chemotherapy for different conditions and different stages, but this isn't the way to go about it, and therefore I support its removal. WhatamIdoing (talk) 23:34, 4 January 2010 (UTC)

Light water/DDW

Added a section on light water (aka deuterium-depleted water). There are certainly some studies which show it as a beneficial adjunct to chemotherapy, but seem to be clustered in eastern Europe. If there are some faults with these studies or this form of therapy, please mention them not only here but at the water and light water pages as well. -LlywelynII (talk) 11:38, 7 January 2011 (UTC)

Effect on different types of cancer

I reverted a section on chemotherapy use in different cancers because I thought it wasn't specific enough leading to oversimplification, and because it appeared to contain some fundamental errors. Here's the diff.

—Preceding unsigned comment added by 124.157.189.136 (talk) 10:09, 29 June 2009 (UTC)

By what measure is small cell lung cancer very chemosensitive and testicular cancer only partially? Not survival or remission at least. This should be more clear before we re-add a similar overview.


--Steven Fruitsmaak (Reply) 19:05, 31 January 2009 (UTC)

The idea that oat cell cancer responds to chemotherapy but testicular does not is in the original souce on gpnotebook.co.uk. Similarly the "fact" that large bowel and other types of lung cancer do not respond is in the textbook cited. However, if you have personal experience that chemo is used in those tumours than obviously the primary source is wrong. It may be too difficult to classify cancers into four groups (this classification is in the primary sources) but I do think it would be a worthwhile addition to give some idea in which cancers chemotherapy can be used. Perhaps a list of cancers where chemotherapy is used and cancers where it is never used would be more objective.

Nathan Cole (talk) 10:34, 1 February 2009 (UTC)

I think the problem lies in the translation between "curative use", "adjuvant" and "palliative" and "cure, partial or non-responsive". Furthermore, there are more complexities such as neo-adjuvant use, the influence of different stages in which the cancer can be diagnosed. If we want to create an overview along the lines you suggested, I think we should explain the words palliative, curative, adjuvant etc. and use guidelines from the National Comprehensive Cancer Network (http://www.nccn.org/). I don't think a simple list will do; we need a short description of the place of chemotherapy in the treatment of each cancer. --Steven Fruitsmaak (Reply) 21:03, 1 February 2009 (UTC)

What about the efficiency of chemotherapy treatment in various cancers? —Preceding unsigned comment added by 87.68.144.240 (talk) 21:55, 13 March 2009 (UTC)

  • Section on/mention of intraperitoneal chemotherapy?
Ovarian Cancer#Treatment mentions this with one reference. The pubmed search review[pt] "intraperitoneal chemotherapy" gives 270 entries, dating back to 1983, with 1037 entries without the review restriction.

RDBrown (talk) 12:20, 23 March 2009 (UTC)

Secondary Neoplasm due to Chemotherapy

More emphasis in this article needs to be placed on the secondary cancers that appear after treatment with chemotherapy. There are a number of studies which have shown the chance of secondary cancer occurrence is quite high. I will try and find up-to-date articles to add, unless someone beats me to it. MrAnderson7 (talk) 23:08, 27 April 2009 (UTC)

Quality of Life

There needs to be an inclusion in the article of the quality of life of the patient undergoing treatment. There have to be many studies in this area. Can someone help with this? for example:

PMID 1283035
PMID 15751002
PMID 16493256
MrAnderson7 (talk) 02:30, 4 June 2009 (UTC)
Hi MrAnderson7,
The last source is probably the best, as the first two are primary sources. I would integrate it into the "side effects" section.
IMO the more important point to make is that quality of life depends on the specific regimen. A person taking imatinib has a very different set of side effects, and a very different quality of life, than a person on the red devil. WhatamIdoing (talk) 00:21, 1 July 2009 (UTC)

Also see Chemotherapy (oncology), it's safer!--86.25.4.192 (talk) 20:07, 11 July 2009 (UTC)

Side effects

Current chemotherapeutic techniques can have a range of side effects mainly affecting the fast-dividing cells of the body. These include the mouth, digestive system, skin, hair and bone marrow.
Most frequent and most important side-effects of chemotherapy :

[2] [3] [4] [5][6] [7] [8] [9] [10] [11] [12] [13] [14] [47] [48] [49] [50] [51] [52] [53] [54] [55] ..://www.newstarget.com/016387.html ..://www.thecancerblog.com/2006/03/09/fish-oil-may-lessen-chemotherapy-side-effects/ ..://www.lisaschaos.com/lisas_chaos/cancer/index.html ..://www.newstarget.com/016387.html ..://www.thecancerblog.com/2006/03/09/fish-oil-may-lessen-chemotherapy-side-effects/ ..://www.lisaschaos.com/lisas_chaos/cancer/index.html

--86.25.4.37 (talk) 19:53, 10 July 2009 (UTC)

--86.25.4.37 (talk) 19:56, 10 July 2009 (UTC)


The treatment can be exhausting physically for the patient.
Sometimes the complete myelosupression is the intended treatment that is in these cases followed by allogenic or autogenic stem cells transplant.

However some patients still develop diseases such as fungal tuberculosis because of this interference with bone marrow.--86.25.4.37 (talk) 19:43, 10 July 2009 (UTC)

Q.V.--86.25.6.205 (talk) 18:58, 10 July 2009 (UTC)

This section really ought to be turned into paragraphs of readable prose, like this:

Different chemotherapeutic drugs cause different side effects. Many drugs kill fast-growing cells and often produce side effects like sores in the mouth, nausea, vomiting, diarrhea, and hair loss. Weight loss, dehydration, and malnutrition may occur if nausea interferes with normal eating. Many of these drugs also kill blood cells or impair the production of new blood cells, which frequently results in anemia, decreased blood clotting, and immunosuppression, which can cause minor infections to become serious.
Anthracyclines can damage the heart....

This approach is much more encyclopedic in style, and also more educational, because it puts the information in proper context instead of a laundry list. ("Laundry lists" also tend to attract a particular problem with new editors repeating items because they didn't happen to see their 'favorite' in the list.)
Finally, as a general rule of thumb, we'd prefer an article about a serious medical problem to cite the best quality sources, such as a medical textbook or a major journal review article, instead of websites. For example, this book (p 266-267) has some useful information, including some information about which drugs cause which problems. WhatamIdoing (talk) 00:49, 1 July 2009 (UTC)

Controversy

Let's make a Chemotherapy controversy page and start the fight for the truth!--86.25.8.152 (talk) 18:35, 29 June 2009 (UTC)

What Controversy? Chemotherapy is a form of medically assisted suicide in most cases. It might buy some time, but like for radiotherapy in the very best case, you gain 12-15 years, but in 90% of the cases, not a single minute. If you are lucky, you fall into those who survive until you die of the radiotherapy and chemotherapy damage that was done to you, from curing your first cancer. Just tell people the truth, even when they don't like it. I have yet to meet anyone that did not ultimtely die because of radiotherapy or chemotherapy. In fact, the studies that prove the point are being withheld. And there are no cases... after 15 years... they're all dead or in the process of fighting the damage the first use of these methods did to them. Sorry... but someone out to be honest with the patients. We all die one day, live with it! Those who claim otherwise act like "snakeoil" merchants.

Yep!--86.25.15.120 (talk) 11:32, 30 June 2009 (UTC)

The first step is finding high-quality reliable sources that address this issue. A handful of "activist" websites are not sufficient, because you need to fairly represent all sides. WhatamIdoing (talk) 00:49, 1 July 2009 (UTC)

Or dose this mean any renegade view that dose not 'fit inside the box' as the saying goes?--86.25.9.230 (talk) 18:21, 10 July 2009 (UTC)

Some of us have found ourselves stuck between, on the one hand, noticing that negative effects and potential limitations (or just "not working") of conventional therapies are being swept under the rug, while at the same time being equally if not more dismayed by 'alternative' therapies that are anecdotal at best. It would be very unfortunate if a long list of word-of-mouth unproven alternatives is what this page became. So it's best to start modest and be on solid ground. Here's a possible start:

http://www.drweil.com/drw/u/ART03060/Treating-Cancer-With-Integrative-Medicine.html and http://www.drweil.com/drw/u/id/ART02724 (which is critical of radiation therapy more of chemotherapy but still relevant towards outlining integrative/alternative approaches) (A link related to the second one above but which I've not fully read is http://www.drweil.com/drw/u/ART02962/Living-Well-Using-Weil.html ) Hope this helps.--Harel (talk) 16:20, 24 August 2009 (UTC)

The first link doesn't actually say much about chemotherapy beyond a very general 'some side effects need treatment' kind of statement. It actually makes a bigger point of very traditional lifestyle changes, like smoking tobacco is unhealthy, as is being obese.
The second two are 100% the personal experience of a single patient, and thus are not really useful for anything -- even if they talked about chemotherapy itself, which they don't. Instead, the subject is her rejection of radiation and her decision (after surgical excision of the last tumor) to add some non-chemotherapy treatments to pharmaceutical anti-cancer drugs to (hopefully) prevent recurrence.
The biggest problem is that none of these links actually address anything about a "controversy" related to "chemotherapy"; they're about Andrew Weil's idea about treating cancer -- an approach that includes everything that modern evidence-based medicine offers, plus comfort care, risk reduction, and so forth.
(BTW, Wikipedia already has a list of Alternative cancer treatments.) WhatamIdoing (talk) 19:56, 24 August 2009 (UTC)
I agree with several of your points, which is why the intention of my suggestion for the second and third links was to offer the above comenters a starting place from which to launch a more indepth search. The first link does include "Very traditional lifestyle changes like (ending) smoking..and obesity" as you say but also mind-body medicine and medicinal use of cannabis, and other not so traditional examples, but that quibble aside, it's more important to notice that the author of that article, Donald I. Abrams, M.D., who has almost thirty years experience as an oncologist, does contain one important criticism of traditional oncology (of which chemotherapy is a part) or 'modern western oncology' as he calls it, namely using a weed metaphor for cancer, the critique is that "Modern western oncology is focused on destroying the weed while integrative oncology concentrates on the soil the weed grows in and on making the soil as inhospitable as possible to the growth and spread of the weed." This is a critique not of what it does but what it does not (additionally) do, of course; there are also critiques out there for the "what it does" part. He also makes a second critique of what may be lost via the large move to specialization. These critiques, certainly, could be included in this article, though the strong feelings (on both sides or all sides) of this debate are stronger than mine are, at this juncture.
A second point is that another article might find use for the references, however, that would not be "alternative cancer treatments" but rather "integrative" as this latter has a very distinct definition of not being only "alternative" but rather, the combination of (parts of) "traditional" and (certain) "alternative" treatments (there is a quote by Weil that states that integrative medicine includes what I just said, plus something of a wider framework, but for our purposes to point out it is not identical or very close in meaning to 'alternative', this rough definition will suffice) So the references might be good for a wikipedia page on Integrative Medicine Treatments for Cancer
Interestingly, while wikipedia has a page about one particular journal on this topic, http://en.wikipedia.org/wiki/Integrative_Cancer_Therapies_(journal) there doesn't seem to be a page on the topic. A bit like having an entry about a journal about research on X without a page on X..maybe some of the more active members might be motivated to start such a wikipedia entry.
On the narrower point, I do wonder if there is opposition in some quarters to even having, or allowing a "criticism" section in the main article on oncology. The above example citing Dr. Abrams certainly indicates real, credentialed, and experienced veteran oncologists who have some criticisms. Will they be allowed into wikipedia without an edit war? I hope so.

--Harel (talk) 22:11, 24 August 2009 (UTC)

You seem to conflate treating side effects (which is what cannabis is recommended for in the source you link) and the many forms of treatment for cancer (which you'll find at Cancer#Treatment) with "using chemicals to kill cancer cells" (which is the actual topic of this article). For example: quitting smoking prevents cancer, but tobacco abstinence is neither a kind of chemotherapy nor a method of killing cancer cells with chemicals ("chemotherapy").
Chemotherapy is not a synonym for "cancer treatment", and this article should not contain information about cancer treatments that are not this kind of cancer treatment. For example: This article should not contain information about surgical excision of tumors, even though surgery is (for solid tumors, when possible) a much more effective treatment for cancer (by itself) than chemotherapy (by itself), simply because surgery is not chemotherapy. (The combination of the two is usually better than either alone.) Similarly, this article should not contain information about weight loss, or meditation, or mushrooms, simply because they are not chemotherapy. All of these things can be (and are) addressed in Cancer#Treatment, but not in Chemotherapy.
Does my interest in making Wikipedia's article about chemotherapy be focused entirely on chemotherapy make sense to you? WhatamIdoing (talk) 01:48, 25 August 2009 (UTC)
"You seem to conflate treating side effects (which is what cannabis is recommended for in the source you link" if you keep reading you will note that he also says, "We now also appreciate that some components of cannabis may have significant anti-cancer effects." This is not central, just to clarify. Now to the more central issue:
I agree with you that the majority of Criticisms section in an article on Chemotherapy should be chemotherapy-specific; however, I have edited enough Wikipedia articles to note that often when article X is on a sub-issue of article Y, there is a mention (sometimes brief, it is true) or some counter-issues, and/or criticisms, and/or cross-references, in both of the wikipedia articles, both the one on X, and the one on Y. Therefore, I fully agree that an extensive treatment of the criticisms of conventional cancer therapy belongs in a section of the article on conventional cancer therapy, a Criticism section for Chemotherapy would not only include what's directly criticized, but also mention of some criticisms of what the "package" which chemotherapy typically belongs to, lacks. So the fact that (according to the cited oncologist for example) conventional chemotherapy is not typically part of a treament that includes not just "de-weeding" but also "building weed resistant soil" is, indeed, de facto also a criticism of chemotherapy, or "of the practice of chemotherapy" as it applies and as it exists in the real world. The article needs to address criticism of chemotherapy as-it-is-practiced (indeed, long-term success rates are tied to whether "anti-weed soil is built" alongside the de-weeding...) insofar as "this is relevant information the potential consumer/user of chemotherapy should know", a standard which certainly seems applicable here -- again with the caveat that a shorter mention here (and longer elsewhere) I agree is reasonable..but when 30-year oncology veterans point out to something that's not included (if something is "not inside my house" then it is also "not inside my kitchen" automatically; likewise, "not included in the chemo-plus-[etc]" package a fortiori means, "not included as part of chemo") it is certainly a critique of chemo-as-it-is-practiced..


So, a brief mention of, "some experts including oncologists have argued that" chemotherapy is not often partnered with "making the soil as inhospitable as possible to the growth and spread of the weed." with reference to Dr. Abram's article, would certainly be appropriate in a Criticism section for this article, while wider-ranging critiques that go into greater depth about "What's missing" could and should go into a critique section of traditional western cancer treatment or oncology. I hope this is a middle-ground we can agree on --72.84.179.34 (talk) 03:17, 25 August 2009 (UTC)
I don't understand why you want to add, e.g., "Cancer patients would live longer lives if they maintained a healthy weight" specifically to the chemotherapy article, but not to the articles on cancer surgery, cancer radiation therapy, cancer immunotherapy, and so forth. This supposed criticism of chemotherapy is equally true and equally valid for every single form of cancer treatment, including alternative cancer treatment. Why are you focused on putting this (true, but off-topic) kind of statement here, instead of in the main Cancer#Treatment section, where it belongs?
Weil's beliefs are not a "critique of chemo-as-it-is-practiced"; they are a critique of cancer-treatment-as-it-is-practiced. He has the same views about the treatment of those cancers for which chemotherapy is never used by mainstream oncologists. WhatamIdoing (talk) 04:12, 25 August 2009 (UTC)

The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies.

fiocco59.altervista.org/ALLEGATI/MORGAN.PDF (original on U.S. National Library of Medicine National Institutes of Health - http://www.ncbi.nlm.nih.gov/pubmed/15630849)

RESULTS: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA.

CONCLUSION: As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.

What is irritating is the arrogance of official medicine. Even without statistics, we are aware of failure in this struggle. Simply, from 1971. (when US declared ,,War on cancer) experiments are not result in treatment more than by the horror that unhappy patients are exposed. —Preceding unsigned comment added by 109.121.16.197 (talk) 13:16, 18 September 2010 (UTC)

Corazon Aquino

It killed her- [[58]]!--86.25.2.154 (talk) 19:07, 7 August 2009 (UTC)

You meant- "Between Christmas 2007 and New Year 2008, Aquino experienced periodic fluctuations of blood pressure, difficulty in breathing, loss of appetite and remarkable loss of weight. Some days after, her doctor confirmed that she had colorectal cancer to the Aquino family. In the middle of March 2008, she confided the nature of her disease to a close friend, priest Catalino Arevalo.[[59]]

Note on archives

My edit summary in this edit to the chemotherapy talk page makes no sense now, because I combined the two archives. The old archive 1 was botched, so I combined it with archive 2, then moved the expanded archive to Talk:Chemotherapy/Archive 1. To make it clear: the history formerly at Talk:Chemotherapy (oncology) is now at Talk:Chemotherapy/Archive 1. Graham87 06:58, 26 December 2009 (UTC)

Jargon

I picked the Nausea and Vomiting section for this tag, since it's full of words you just don't use every day. Example: The vomiting center is stimulated directly by afferent input from the vagal and splanchnic nerves, the pharynx, the cerebral cortex, cholinergic and histamine stimulation from the vestibular system, and efferent input from the chemoreceptor trigger zone (CTZ).

I think this section and probably others, would benefit from saying something like, "Chemotherapy can cause nausea and vomiting, due to the way the drugs interact with the body.""There are drugs to help control nausea and vomiting, and they are..." and then maybe a section on the mechanism. There is useful information here, but some of it is well hidden deep within the afferent input of the vagal and splanchnic nerves...but that afferent input is stimulated by reading jargon I can barely understand. Imagine if you're a soon to be cancer patient and you come to WP to find out about this, and you have wade through vocabulary that was written by, and seems to be intended for, doctors and medical school students. Hires an editor (talk) 02:33, 27 April 2010 (UTC)

Is there any particular reason that you didn't boldly fix it already? WhatamIdoing (talk) 04:11, 27 April 2010 (UTC)

Criticism

The usual rules apply. Specifically, minority/alternative/fringe/pseudoscientific (pick any that apply) views must be presented as being that type of view, and widely accepted mainstream views must be presented as being the widely accepted mainstream views. Wikipedia does not pretend that all views are equally valid merely because all views can be documented to exist.
Of probable relevance (based on previous editors' mistakes):
  • Cancer prevention is not cancer treatment.
  • Chemotherapy is not the only kind of cancer treatment, and most cancer patients receive multiple forms of treatment. Please be careful to avoid the low-quality sources that have trouble differentiating between chemotherapy, surgery, immunotherapy, and radiation.
  • Taking "natural" drugs is technically a form of chemotherapy. For example, laetrile is a completely ineffective form of "natural" chemotherapy. WhatamIdoing (talk) 21:47, 12 September 2010 (UTC)

WP:CRIT is a useful essay when it comes to content labeled "criticism of ...". WhatamIdoing rightly warns that we should really only discuss criticisms of the concept of chemotherapy, which is really a lot more limited that criticisms of mainstream oncology. There is certainly stuff to be discussed; for instance, a 2008 report in the UK pointed out that chemotherapy is sometimes given in the face of unacceptable potential harms and without safety nets for complications (link). That seems to be an example of "criticism of chemotherapy". Otherwise, WP:WEIGHT, WP:NPOV and WP:NOR apply in their fullest sense of the word. JFW | T@lk 13:29, 13 September 2010 (UTC)

Types of treatment

Read this page some time- --://www.ehow.com/video_4872391_types-chemotherapy-drugs.html.--Wipsenade (talk) 10:31, 7 January 2011 (UTC)

Did Alexander Fleming really discover (or even "isolate") penicillin?

These discussion notes have been added in response to a request by user TenOfAllTrades to explain in more detail my recent decision to edit the Chemotherapy article to include a carefully written footnote (that TenOfAllTrades then decided to delete although I have since reinstated it as I believe it's both necessary and correct even if only as a footnote) pointing out that, contrary to popular folklore and belief, Alexander Fleming did not discover penicillin, though as it happens did rename it (and the name he chose is still in use today).

TenOfAllTrades then further conjectured that even if Fleming hadn'd discovered penicillin perhaps at least he was the first to isolate it? This view is also mistaken; not only did Fleming not personally isolate the substance at all, but in fact it had been isolated and researched (and even published) by a variety of people many years before Fleming first became involved.

The late Prof Sydney Selwyn was a leading bacteriologist and medical microbiologist. He was also an acknowledged authority on the History of Medicine. During his career he worked closely with a number of the key research colleagues of Fleming, although so far as I’m aware Selwyn did not actually work with or meet Fleming himself (who died whilst Selwyn was still at medical school in Edinburgh). In summary; as not only a medical historian but also a practicing medical microbiologist leading several world-class research teams in the relevant field (and also at London University, though at Westminster rather than St. Mary’s) Selwyn was therefore without doubt one of (if not the) closest and best qualified people to comment on what Fleming did, or did not, do professionally in the field of microbiological research.

Selwyn's definitive book on this subject (at least in respect of it’s history, where the book clearly excels, but not necessarily in terms of current clinical use or practice with β-lactam drugs as the book was written some time ago), “The beta-Lactam Antibiotics: Penicillins and Cephalosporins in Perspective” (Hodder and Stoughton, 1980, ISBN 0-340-22523-8) is unfortunately currently out of print and also quite a rare book (though is often available second hand, for example please see ‘abebooks’) . Fortunately I happen to have in my own library a copy of it (which, incidentally, was presented to me personally by Prof. Selwyn just after he wrote it almost 20 years ago to the day). From reading the first chapter of Selwyn's book it seems quite clear that what became known as penicillin had been recognized and researched, though to an extent in obscurity, for at least 60 years by various people around the world before Fleming unwittingly and somewhat haphazardly rediscovered it. There’s plenty of evidence (in addition to Flemings own notes and published writings) to show that Fleming didn’t really know quite what it was that he’d found; he did not correctly identify what he had and did not know how it had got there but could at least recognise the significance of what it appeared to have been doing whilst he’d been on holiday (please see page 21 of Selwyn’s book)!

On page 16 of his book Selwyn states that Alsberg and Black isolated what they called "penicillic acid" (i.e. penicillin) in 1913, in other words 15 years before Flemings basic "discovery" and another year or more before Flemings colleagues (Frederick Ridley and Stuart Craddock, please again see page 21 of Selwyn's book) subsequently proceeded to try and isolate "penicillin" before Fleming allowed the work to become temporarily suspended (and without publication, though of course fully recorded within their department).

I have other material (from other sources) to show that Fleming was in fact a thoroughly well liked and respected head of department and leader of his team, even if not a particularly good scientist himself. It seems that, privately at least, Fleming felt he did not personally really deserve even the share of the Nobel Prize he subsequently received for his part in the progress of this pioneering work. However it appears he also fully realised that he was really accepting it on behalf of a large number of co-workers and that its award to him brought great satisfaction and prestige on all concerned.

In summary it is conclusively recognised, at least by dull pedantic academics like myself even if not the public at large, that despite being a thoroughly well liked and jolly good chap Fleming did not actually discover, or even first isolate, penicillin. He did however name it as well as receive a share of a Nobel Prize for his role as leader of a team of pioneering researchers in developing, over several years, the knowledge required to subsequently produce useful antibiotics from it.

As an encyclopaedia it is important that articles in Wikipedia properly distinguish fact from fiction, even if only within the confines of an esoteric and relatively (though most probably necessarily) “wordy” footnote Smile.svg .....Barryz1 (talk) 18:22, 25 September 2010 (UTC)

PS. When I have time (unless someone else would like to do it first?) I'm thinking of carefully going through History of penicillin and related articles to correct and update them accordingly as it's high time they were improved. Barryz1 (talk) 18:29, 25 September 2010 (UTC)
For now, I've removed the entire reference to penicillin from the lead, as it was just being used as one example in a list of early chemotherapeutic agents. (The sulfa drugs are mentioned, and will serve adequately.) We don't really need to import a historical controversy to this article, given its very tangential nature. It would also be reasonable to just name the drugs without listing their putative discoverers. TenOfAllTrades(talk) 19:01, 25 September 2010 (UTC)
...and for now I've added it back. I am not interested in non-NPOV rivalries or jealousies. Looking through the history of this article I can see that the important reference to Penicillin appears to have been added on 19:12, 5 October 2002 by user AxelBoldt and its (erroneous) attribution to Fleming included on 07:54, 18 April 2004 by user Kpjas. Clearly it has therefore been there, and heavily scrutinized and no doubt found of interest and value to a large number of people, for many years. Far more people have probably heard of penicillin than sulfa drugs and so it's inclusion makes good sense.
TenOfAllTrades; Just because you personally didn’t like my clearly accurate and relevant footnote you amended the reference and apparently “guessed” or “conjectured” a theory of your own (that perhaps Fleming was the first to “isolate” penicillin even if, perhaps disappointingly, it turns out he hadn’t after all actually been the first to discover the stuff). When I patiently showed that you were also mistaken (though I’m sure not alone) in that belief you simply - unilaterally - removed an interesting, important and helpful item of information that has demonstrably been available on wikipedia for many years.
In your apparent pique you have justified yourself by now claiming we are "importing a historical controversy into this article" whereas in reality I added a footnote (a footnote, note) to discreetly correct a factual error that has been in this article for perhaps 6 years. What you have done in response is tantamount to what was, until recently, termed "[Vand]" (now apparently a sub-set of accuracy & damage), which I do find surprising for an editor of your experience and standing. I’ll assume (though ordinarily try to assume nothing) that this was simply an oversight on your part.
May I suggest that if you really have a problem with this you at least leave the longstanding information (reference to penicillin with attribution to Fleming that’s been included since 2002 and 2004 respectively) together with the important footnote I recently added (which is clearly correct and should have been there all along – as it happens I actually am well qualified to comment) and instead air your views and grievances (if that is the right word? – apologies if not) via the appropriate WP:DR. Let other experienced editors independently read (and carefully check) all that each of us have contributed then advise us of their findings and decision - I'll be happy with whatever they say. That I think would be the proper thing to do in accordance with WP:Policy. If you instead unilaterally delete the relevant words again then I will need (with great reluctance) to seek advice from the WP:administrators as to the most appropriate course of action to protect this (and any related) article.
Sorry if for any reason I've unintentionally annoyed you and thanks in anticipation of your understanding now that I've explained.
Finally please let’s not fall out over this - - - - - Barryz1 (talk) 20:19, 25 September 2010 (UTC)
I think it should be removed.
Barry, the big problem is our rules against WP:COATRACKing. The history of penicillin is so incredibly unimportant to this article, that even mentioning it in a footnote is inappropriate.
The people who are reading this article are probably looking for general information about drugs used to treat cancer, either for a school report, or because a friend or loved one is receiving chemotherapy. Now picture that person, and try to imagine him/her saying, "Well, my friend seems to be dying of lung cancer, and his hair all fell out, and he's coughing a lot -- but what I really need right now, is a little lesson on the history of antibiotics!"
And if you can't do that with a straight face, then that should be your indication that this information doesn't actually belong on this page. WhatamIdoing (talk) 20:55, 25 September 2010 (UTC)
Thanks for your comments WhatamIdoing - I agree with you that we don't need a history lesson with this particular article, however if people do insist on including such details then I'll do my best to make sure they're at least correct, and that (as far as possible, and time permitting) the article's style and content is reasonably consistent.
Thanks TenOfAllTrades - I much prefer your newer approach and feel that what you've done now is essentially correct. The problem before (as you know) was that people apparently wanted to attribute discoverers to both sulfonamides and penicillin, which was easier in the case of the former but more problematic for the latter. Personally I was neutral (though if anything slightly sceptical) about the need to mention Domagk or Fleming but did feel if their names were to appear then it was most important to at least add a key footnote for accuracy and by way of clarification. Obviously having one name without the other (as you attempted as a "compromise", perhaps to save "face") was unsatisfactory as it was unbalanced and could raise more questions (at least in the minds of people who notice these things) than it answered. Removing the reference to penicillin altogether as you then unilaterally decided (and with rather weak justification attempted) was even less satisfactory. Your latest idea of avoiding the problem altogether is far more appropriate! (It would have been somewhat embarrassing - so I'm glad it's now unnecessary - to have had to take further action over this).
All of this has, however, raised my awareness of yet another weakness in wikipedia's "narrative"; in this case the perpetuating of the myth in various of its articles of Fleming's "accidental discovery", which is in some ways akin to a number of other now largely debunked myths, e.g. the old idea that Columbus was either the first (which he was not) to discover that the earth was not flat, or else at least the first (which again he most certainly was not) to prove it wasn’t. It's gross inaccuracies and misconceptions such as these (and their frequent defence by well meaning and hardworking, but nonetheless woefully unscholarly and incorrect editors) that regularly brings Wikipedia into disrepute – hence my desire (time permitting) to invest a little energy in occasionally correcting a few when I notice them - even though you can see what happens sometimes when I try!
Kind Regards Emblem-cool.svg....Barryz1 (talk) 11:16, 26 September 2010 (UTC)

Autoimmune Inner Ear Disease (AIED)

Chemo is apparently one of the ways to treat Autoimmune Inner Ear Disease (AIED) these days- [[60]]. --Wipsenade (talk) 10:41, 7 January 2011 (UTC)

Alkylating agents

In the section of alkylating agents the substances cisplatin, carboplatin and oxaliplatin are listed as examples. I think this should be changed, as neither of these agents are alkylating agents. These compunds work by forming crosslinks in the DNA, a lesion that is very different from alkylated DNA. Why not list true alkylators such as melphalan or chlorambucil instead? Sniffe35 (talk) 15:54, 9 March 2011 (UTC)

Thank you for your suggestion. When you believe an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top. The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to). WhatamIdoing (talk) 16:06, 9 March 2011 (UTC)

light water

The light water chapter report citation with low scientific value so I delete it. I mean, the impact factor of the journals are extremely low, the number of published paper in the field is also very low. — Preceding unsigned comment added by Gutul (talkcontribs) 22:32, 23 February 2011 (UTC)

Don't know how that ever got into the article. Thanks for removing it. JFW | T@lk 23:05, 23 February 2011 (UTC)
Agree. Mikael Häggström (talk) 15:51, 16 May 2011 (UTC)

Efficacy (2)

I think we should add this metareview to the article, it's from 2004. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. http://www.ncbi.nlm.nih.gov/pubmed/15630849?dopt=Abstract RESULTS: The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA. — Preceding unsigned comment added by 84.114.147.43 (talkcontribs) 22:36, 23 February 2011

That article is probably one of the most misunderstood and often quoted studies in all cancer-related literature. Virtually all the looney-tunes sites use it as "proof" that chemotherapy is ineffective. Including this study in the article would require that it be analyzed simply because it is so often misinterpreted as meaning that the survival rate from chemotherapy is only 2%. By including the article without discussion, you run the risk of causing cancer patients to reject medical treatment that might save their lives. In point of fact, most cancers are not treated by chemotherapy alone: they are treated using multiple modalities. What Morgan, et al, attempted to put a number on was what percentage of the 5-year survival rate is due only to chemotherapy. They did not look at all cancer, nor did they even look at cancers, such as leukemia, whose main treatment modality is chemotherapy alone, and they ignored childhood cancers, more often (and successfully) treated with chemotherapy, completely. They did not even bother to separate out cancers for which chemotherapy is not indicated. A good example of what they did say regards head and neck cancer. When treated early by radiation and/or surgery, the cancer is highly curable, and adding chemo into the mix offers no increased survival benefits. With advanced disease, there is an improvement by adding chemo. By adding together various study data, they came up with 2486 adult Australians with head and neck cancers, and, of those, they estimated, using their fudge factors, that 63 of those who were alive after 5 years would have been dead had it not been for the chemotherapy. The question these authors raise in their article is, when you look at all of these people who lived, and consider the cost, is there any real benefit to using the chemotherapy. I suspect that, if you could have asked those 63 people, you would have gotten a different answer than the wackos who contend that the chemo doesn't do anything. A major limitation of the meta analysis is that it covers only 5 year survival, which ignores the fact that the benefit of chemotherapy for a cancer such as breast cancer does not become statistically apparent until long after, such as at the 10 year mark. Another major limitation is that it does not examine the actual question of whether the individual studies that they pool together are actually representative of all cancer treatment. Aside from not looking at all cancers, issues and treatments that are already "decided" in the minds of the medical community are not likely to be studied any more, so how representative these pooled studies are is open to question on several grounds. In addition, the contribution of chemo is highly variable: someone with a mind would probably note that each cancer is different. In the case of Hodgkin's disease and testicular cancer, for instance, chemotherapy is responsible, according to their figures, for about 2 out of every 5 survivors. Any inclusion of this article would need to point out that, even by their figures, there were 3305 Australians, out of 154,971 in their data pool, who were alive only because of the chemotherapy. That is a huge number of people who would otherwise be dead. GeorgeButel (talk) 18:44, 29 March 2012 (UTC)GeorgeButel

I think that we can and should provide that information. If chemotherapy directly saves the lives of two out of every 100 cancer patients, and makes no particular difference to the other 98 (who would live or die with or without it), then we can tell people that.
We have no business trying to push patients to make the "right" choice. If chemo actually has a 2% chance of saving their lives, they should know that. It's up to them to decide whether a 2% chance is worth the costs. (It's up to their oncologists to tell them whether that 2% overall statistic has anything to do with their own case. Chemotherapy contributes far more to some cancers and far less to others. It also depends on the type of chemotherapy chosen, and the individual patients' characteristics. But that's all for the personal physician, not for the encyclopedia.) WhatamIdoing (talk) 20:44, 29 March 2012 (UTC)

We should present the article, because it is referred to so much. Yet it was soundly criticized in that very same journal later by Mileshkin, et al,(see http://www.ncbi.nlm.nih.gov/pubmed/15997929; it's a letter or comment, not an article, so no abstract is available.) But its statistical misrepresentations are so pervasive that it has to be analyzed. You yourself, WhatamIdoing, are an example of the misinterpretation of the data: chemo does not have a 2% chance of saving these people's lives. People for whom chemotherapy was not indicated were included in the figures. And, even so, of the 98%, some of them were helped by the chemotherapy, some of them didn't receive it. Chemotherapy obviously didn't extend the lifespan of people who didn't get it, yet the authors, for reasons known only to them and to God, included those who did not get chemotherapy. The only reasonable explanation would be an attempt to lower the apparent efficacy rate. In trying to get Mileshkin's full text online to use as a citation (which I haven't found yet), I did find an excellent blog that destroys the "review" of Barton, et al; see http://anaximperator.wordpress.com/2009/09/02/only-3-percent-survive-chemotherapy/. People need full information: that means pro and con. There are severe problem with the war on cancer, but there are severe problems with the other camp also. We have to have a balanced view; "Just the facts, ma'am" (Joe Friday).GeorgeButel (talk) 21:37, 29 March 2012 (UTC)GeorgeButel

I have found the text of the rebuttal of Mileshkin, Rischin, Prince and Zalcberg. The text of their comment is available in a footnote at http://web.archive.org/web/20110519062342/http://esowatch.com/ge/index.php?title=Germanische_Neue_Medizin (from Clinical Oncology. Volume 17, Issue 4, Juni 2005, Seite 294. doi:10.1016/j.clon.2005.02.012): "We read with interest the paper by Morgan et al. [1], which claimed to assess the contribution of curative or adjuvant cytotoxic chemotherapy to survival in adults with cancer. We are concerned that their approach underestimates the contribution of chemotherapy to the care of cancer patients. By using all newly diagnosed adult patients as a denominator, despite the fact that chemotherapy is not indicated for many of these patients, the magnitude of the benefit in many sub-groups is obscured. Furthermore, the authors use a time-point of 5 years to assess effect on survival. This will underestimate the efficacy of chemotherapy because of late relapses....[here they give data on long term relapses of breast cancer]...The authors omitted leukaemias, which they curiously justify in part by citing the fact that it is usually treated by clinical haematologists rather than medical oncologists. They also wrongly state that only intermediate and high-grade non-Hodgkin’s lymphoma of large-B cell type can be cured with chemotherapy, and ignore T-cell lymphomas and the highly curable Burkitt’s lymphoma. They neglect to mention the significant survival benefit achievable with high-dose chemotherapy and autologous stem-cell transplantation to treat newly-diagnosed multiple myeloma [4]. In ovarian cancer, they quote a survival benefit from chemotherapy of 11% at 5 years, based on a single randomised-controlled trial (RCT), in which chemotherapy was given in both arms [5]; however, subsequent trials have reported higher 5-year survival rates. In cancers such as myeloma and ovarian cancer, in which chemotherapy has been used long before our current era of well-designed RCTs, the lack of RCT comparing chemotherapy to best supportive care should not be misconstrued to dismiss or minimise any survival benefit. In head and neck cancer, the authors erroneously claim the benefit from chemotherapy given concomitantly with radiotherapy in a meta-analysis to be 4%, when 8% was in fact reported [6]. The authors do not address the important benefits from chemotherapy to treat advanced cancer. Many patients with cancers such as lung and colon present or relapse with advanced incurable disease. For these conditions, chemotherapy significantly improves median survival rates, and may also improve quality of life by reducing symptoms and complications of cancer....Although we fully agree that there is a need for evidence-based assessment of all treatments, the contribution of this type of analysis, with pooling of all cancer patients, is questionable and potentially misleading." — Preceding unsigned comment added by GeorgeButel (talkcontribs) 22:29, 29 March 2012 (UTC)

And as soon as a better paper is available, we'll cheerfully update our information. We can't outrun our sources, and this appears to be the best that exists. WhatamIdoing (talk) 23:53, 29 March 2012 (UTC)
No, we shouldn't be reporting the results of an eight-year-old paper that uses even older data, analyzing it in a non-standard way, making...questionable...judgements about which data, diseases, and outcomes to omit, published in a low-impact journal. Waiting for a newer, 'better' version of this paper requires us to grant the assumption that someone else is going to carry out the same sort of pointless-bordering-on-deceptive analysis.
By analogy, let's assume that the Journal of Automotive Mechanics published the paper "The contribution of tire replacement to automotive repair". At the end of the paper, they conclude that tire replacement contributed approximately 2% to five-year car survival. On closer examination:
  • Did the analysis only look at flat tires? No; it looked at all automotive problems, regardless of severity or cause. All car maladies were considered – including low oil pressure, dead batteries, and fouled spark plugs – regardless of whether or not a tire change is indicated as a treatment.
  • Did all the patientscars considered receive a tire change? No; it would be silly to change the tires on a car with a dead battery. But since the car didn't receive new tires, it's obvious that they didn't benefit from tire replacement, either—so those cases must necessarily count against the benefit of tire replacement therapy.
  • Were all cars that had a flat counted? No; flat tires fixed using the car's own spare, or tires replaced by the owner outside of a registered, national-chain garage weren't included.
Unfortunately, the anti-tire "Alternative Mechanics" lobby insists that this is strong evidence against the value of tire replacement. TenOfAllTrades(talk) 00:27, 30 March 2012 (UTC)
I'd be perfectly happy to learn that tire replacement was 2% of car survival. That would be useful for understanding the macroeconomic issues involved in vehicle maintenance. It might not be useful for planning my own household budget, but it would be useful for understanding the big picture, e.g., whether or not tire replacement was a major component of vehicle maintenance for society (or for other large groups, like corporate fleets).
It's not our job to pick apart the sources and decide whether we personally agree with their methodology. It's our job to figure out whether this is a good type of study. See WP:MEDASSESS:

"Editors should not perform a detailed academic peer review. Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions."

This is a good type of study. Editors' objections to the way that it has been misrepresented by alternative medicine folks, or the way that the authors set up their selection criteria, are not valid reasons for excluding it.
We should, of course, accurately represent its contents, e.g., by pointing out that chemotherapy contributes far more than 2% to testicular cancer and far less than 2% to head and neck cancer. But we should not simply reject it out of hand because we don't like the study, or its results, or the glee with which some crackpots twisted its conclusions. WhatamIdoing (talk) 00:01, 31 March 2012 (UTC)
You're presuming that this qualifies as a "high-quality type of study", which I'm not persuaded that it does. How this study might be relevant to macroeconomic issues of vehicle maintenancecancer therapy is rather dubious (measures such as QALYs or DALYs saved might be more appropriate than five-year survival for measuring economic impact or value of an intervention) but our article isn't even (mis)using this study for that purpose‐instead we're using it as our principal source to discuss the efficacy of chemotherapy.
Misrepresenting five-year survival as the only (or even the primary) measure of efficacy is a serious error made in our article, as is relying so heavily on the summary provided by a single (eight-year-old) publication. TenOfAllTrades(talk) 00:49, 31 March 2012 (UTC)
No, it's not our place to decide whether their endpoints are any good. It's our place to go off to Pubmed and click on "Publication Types, MeSH Terms" and see that it says "Publication Types Review" there, rather than, say, "Publication Types Letter" or "Publication Types Case Reports". That's what we mean by a good type of source: is it, or is it not, a review article? WhatamIdoing (talk) 22:32, 2 April 2012 (UTC)
Ouch, no. We can't abdicate our editorial responsibility by declaring that all review articles indexed by PubMed are suitable for inclusion in Wikipedia. As I see it, there are a couple of interrelated problems here. First, our article is using a single measure (five-year survival) as the sole measure of 'efficacy' of all chemotherapeutic interventions. That error is partly on us, and partly on the Morgan et al. review for making that choice.
The second problem is that our article relies solely on Morgan et al. for our discussion of efficacy. There are literally thousands of review articles discussion various aspects of chemotherapeutic efficacy and which clear the low bar of PubMed inclusion; not all reviews are created equal. Morgan et al. just isn't a very good paper for us to be leaning on, and frankly we probably shouldn't use it at all. I'm not asking you to take my word for it, either. Shortly after the original paper was published, a relatively harsh criticism of its methods (and outright errors) were published in a letter to the same journal [61]; the paper's authors declined to respond or rebut. In the eight years since the paper was published, Morgan et al. has been cited just 21 times in the scientific and medical literature (and only 13 of those cites were in peer-reviewed articles, rather than letters or editorial content) according to Web of Knowledge. Unnervingly, I also note that 7 out of 13 of those article cites were in articles published more than three months after the addition of the 'Efficacy' section to the Wikipedia article in February 2011, and I fear the pervasive influence of Wikipedia may be inappropriately inflating the perceived importance or relevance of this publication. (Consider, for example, this PLoS One article published in September 2011, which cites Morgan et al. just once, solely to support the trivial introductory sentence "Standard cancer therapy generally combines surgery, multi-therapeutic agents and ionizing radiation.") These problems are all aside from the fact that this paper is far out of date, relying on studies between nine and twenty-two years old to draw its conclusions. TenOfAllTrades(talk) 04:21, 3 April 2012 (UTC)

Outdenting, right now I can see following pros and cons to Morgan et al. and our usage of it to characterize the 'efficacy' of chemotherapy:

Pros:

  • The paper is a peer-reviewed review article, published in a journal indexed by PubMed/Medline.
  • It has been suggested that MEDRS means that any paper meeting the above criterion need not (and cannot) be further examined for quality or relevance.
  • The paper surveys the contribution of chemotherapy to the treatment of several cancers, offering a very broad perspective.

Cons:

  • The paper is eight years old, and relies on studies between 9 and 22 years old. (And since five-year survival is used as the primary endpoint, we're looking at patients treated fourteen years ago or more.)
  • The paper was published in a low-impact journal. (Clinical Oncology has an impact factor of 2.294; it's a small fish in a pretty big pond. For comparison, the similarly-named, similarly-scoped Journal of Clinical Oncology has an impact factor of 18.970.)
  • The paper's analysis was strongly criticized by Mileshkin et al. in a subsequent issue of the same journal, both for its curious criteria for data inclusion and for at least one out-and-out error misstating the result of another study. The original paper's authors declined to respond to or rebut the points made in the critique.
  • The paper excludes from consideration a number of types of cancer for which chemotherapy is often an accepted and highly effective treatment, especially the leukemias and childhood cancers.
  • The paper doesn't once actually mention 'efficacy', as even its authors realize that that would be overplaying their hand.
  • Instead, the paper only looks at one endpoint: five-year survival. This suppresses the potential benefits of chemotherapy in preventing or reducing the incidence of late relapses and recurrences (Mileshkin et al. note that in breast cancer patients the ten-year survival benefit of chemotherapy is close to twice the five-year benefit). This also suppresses the impact of any extension in survival that doesn't reach the five-year mark (as with, for example, so-called 'palliative' chemotherapy, which can add several months to median survival in pancreatic cancer, and about a year to median survival in colorectal cancer [62]).
  • The paper is not considered an important or relevant part of the scientific and medical literature, based on the very few times it has been cited. (It has received just 13 cites in other papers and review since its 2004 publication.) The majority of those cites (7 of 13) have appeared in the literature since the article became Wikipedia's sole source for the discussion of chemotherapy's efficacy just over one year ago, which may speak to Wikipedia's pervasive effects. Even then, some of those cites use this paper for trivial background information, instead of for its major conclusions.
  • The paper is inappropriate for a discussion of overall efficacy in any case, as it does a poor job of answering the one question most likely to be asked of our article: If offered a particular chemotherapeutic regimen to treat a given type and stage of cancer, what are the probable benefits (if any) to the patient?

I am going to invite the participants in WP:WikiProject Medicine to review this source and this article, because right now I feel we're doing our readers a tragic disservice. TenOfAllTrades(talk) 15:24, 3 April 2012 (UTC)

Some of these points can be easily solved through editing, e.g., by correcting or tightening up the wording. Others, e.g., the impact factor of the journal, seem completely unimportant to me.
I oppose having a seriously incomplete article. We need to address efficacy. We need to explain why some patients don't get chemotherapy (e.g., because it doesn't work for their cancers) and how important chemotherapy is (ranging from "very important" in leukemias and testicular cancer to "somewhat useful, but not nearly as much as surgery" in breast cancers to "net harmful" for most non-melanoma skin cancers).
It is not the job of this article—of any encyclopedia article—to present complete data on the efficacy for every combination of cancer type, stage, and proposed regimen. Encyclopedias summarize. That means that we're aiming for broad, general statements. People who need to decide whether they should accept the treatment they've been offered should be talking to their oncologists, not hoping that Wikipedia will tell them the answer. We might provide information that will inspire them to ask their oncologist whether the proposed treatment is the sort that will raise their survival from 80% to 81%, or if it will raise it from 20% to 60% (because if it's the first case, then they might decide that the personal and physical costs are not worth the very small benefit), but telling them that there are differences in the utility of chemotherapy is as far as our job goes.
The fact that we don't (currently) have a source that is new or entirely comprehensive should not prevent us from (accurately, which requires some changes) presenting the little information that we do have on this subject. WhatamIdoing (talk) 19:38, 3 April 2012 (UTC)
I have some serious concerns about our citation of this article, outlined here. The bottom line is that we can't make global pronouncements about the efficacy of chemotherapy, because it differs markedly depending on disease and patient factors. Using this article is worse than saying nothing at all. As others have pointed out, its methodology is highly suspect. I accept that we aren't allowed to formally make that judgement (although it's true).

More relevantly, the paper makes erroneous or outdated pronouncements (e.g. that chemotherapy is "essentially useless" in multiple myeloma or renal cell carcinoma). To me, this is a perfect illustration of why WP:MEDRS discourages the use of primary sources. Clearly, chemotherapy is beneficial for many patients with myeloma, renal cell cancer, breast cancer, etc. It's trivially easy to demonstrate a consensus of expert opinion to that effect. Therefore, we shouldn't cite an individual paper here - presented in a way which contradicts expert opinion - as the sole word on efficacy.

I agree that we should address the efficacy of chemotherapy and explain where it's useful and where it's useless. But this paper doesn't do that - it's a dated look at a narrow and reductive question, but we're presenting it as the last, best word on the role of chemotherapy in the treatment of cancer. MastCell Talk 21:03, 3 April 2012 (UTC)

Though it is not a wikipedian's job to judge the quality of a source, we must nevertheless exercise editorial judgment while deciding whether the source supports the specific content being included in an article. In this case, I believe we must honor the intentions of Morgan et al and reduce the scope of the citation. By using subheadings under "Efficacy" suchs as "Economic and policy perspective" and by placing the caveats before the numerical figures, the article becomes, in my opinion, more true to the source and much less misleading for the reader. Wafflephile (talk) 16:37, 4 April 2012 (UTC)

I have just looked at the study. GeorgeButel and TenOfAllTrades raise serious flaws with the methodology and conclusion of the study. I agree with them. Indeed the piece is so blatantly biased that it is hard to believe that the authors didn't have an ulterior agenda. (Given that they work in a department of radiation oncology and the journal is "Clinical Oncology", I suspect that their aim is to discredit chemotherapy, thus placing radiotherapy more prominently.)

WhatamIdoing claims that the "type" of study is good. Only in the most general sense: review articles are generally better (as references in Wikipedia articles) than primary studies. Unfortunately this particular review article is seriously flawed.

In my opinion, this study is unreliable. It seems that WhatamIdoing believes that I am not allowed to use my opinion of reliability when choosing references. Yet I actually do it all the time when editing Wikipedia. Indeed the reason that WP:MEDRS recommends secondary sources over primary is because secondary sources are generally more reliable.

WhatamIdoing quotes this sentence from WP:MEDASSESS: "Do not reject a high-quality type of study due to personal objections to the study's inclusion criteria, references, funding sources, or conclusions." Actually that sentence is grammatically flawed. In this case, the type of study is a review article. Yet we are not rejecting review articles. We are rejecting this particular review article.

Although not explicitly stated in WP:MEDRS, I believe that editors should use editorial judgement to decide whether a given source is reliable. The choice of secondary vs primary sources is only one piece of information to assist with the confirmation of reliability.

WhatamIdoing also quotes: "Editors should not perform a detailed academic peer review." I see no reason why this is so prominently emphasized. In my opinion, it should be removed.

It is also worth mentioning that WP:MEDRS is a guideline. "It is best treated with common sense, and occasional exceptions may apply." Axl ¤ [Talk] 17:44, 18 April 2012 (UTC)

The quoted text about editors not trying to evaluate the quality of sources was added by WhatamIdoing himself: [63]. TenOfAllTrades(talk) 18:37, 18 April 2012 (UTC)
WhatamIdoing is an excellent editor, and I know she's committed to same goal we all are, which is the best possible coverage of medical topics. If she sees a problem, then it's definitely worth seriously considering her concerns.

For me, the issue isn't so much the quality of this particular article (although it is concerningly poor in my personal opinion). It's the idea of making one blanket statement about the efficacy of all forms of chemotherapy in all situations. That just doesn't make sense to me; I think we should cover the efficacy of chemotherapy by disease, since it varies from "nearly universally curative" (in Hodgkin lymphoma, for example) to "possibly no better than palliative care" (in advanced non-small-cell lung cancer).

I just think we're doing a disservice by trying to lump those disparate indications together into a single statement, regardless of whether the authors of a single paper did so. It's evident that experts in the field don't look at chemotherapy efficacy this way; the paper in question pretty much stands out as the sole example of this approach, which speaks to WP:WEIGHT.

By way of analogy, antibiotics are highly effective for some indications (e.g. the treatment of localized soft-tissue infections) and much less effective for others (e.g. as adjunctive treatment in severe sepsis). I don't think we'd lump these indications together to make a categorical claim about how useful antibiotics are, and I don't think it's the way to go here. MastCell Talk 19:47, 18 April 2012 (UTC)

Ten, the problems that we were encountering with that section of MEDRS were discussed repeatedly on the talk page, and my change (one of several efforts to solve the problems) was announced when it was made. To my knowledge, no one has objected (either at WT:MEDRS or at WT:MED) at any point since then.
Axl, if every editor were you or MastCell, I wouldn't be picky about this. But the fact is that 99% of Wikipedia's editors are utterly incompetent when it comes to evaluating the methodology and conclusions of any medicine-related study, and I consequently think it preferable for all of us to avoid this.
Finally, I don't actually care one way or the other about whether the "2%" claim is made. It would be difficult to accurately explain that, and by the time you put all the necessary qualifications on it (considering only cytotoxic therapy, applies only to invasive solid tumors, etc.) it's probably not meaningful to the typical reader. IMO our judgment about this source is better applied to "how" we present the information it contains rather than "whether" we present its information about efficacy.
I think it extremely important to address efficacy somewhere in this article. We need to point out that chemotherapy is responsible for basically all treatment success in hematological malignancies, that it is useless in some cancers, and that it is needless in others. Chemotherapy takes up so much of the typical patient's psychological space that IMO we need to provide information about how much (or, perhaps more accurately, how little) it contributes to ultimate treatment success. Although I'd be happy with some specific examples (e.g., surgery is more important than chemotherapy for colon cancer [where surgery permanently cures half the cases outright] or breast cancer [where, taking all stages together, chemotherapy contributes no more than a couple of percentage points to 20-year survival]), IMO we need to be providing very general information, not a comprehensive list of every cancer and certainly not every possible combination of treatment. And while I see several people saying that if they wrote this paper, they would have made different choices about what to include in it, I don't see anyone suggesting better sources (do they exist?) or trying to provide better information to our readers. Can we try to actually solve this problem and get information to the reader, rather than just complaining about these authors' peer-review-approved choices? WhatamIdoing (talk) 14:00, 22 April 2012 (UTC)

I do not have WP:MEDRS watchlisted. You made the edit to the guideline two years ago, and it is impossible for me to remember how attentive I was at the time that the edit took effect. Of course I assume good faith and believe that you had the appropriate consensus at the time.

" 99% of Wikipedia's editors are utterly incompetent when it comes to evaluating the methodology and conclusions of any medicine-related study. "

When looking at editors of medicine-related articles, that's surely an exaggeration. It's definitely not true of the WP:MED regulars.

" I consequently think it preferable for all of us to avoid this. "

Whenever I read a source, I am sure that I subconsciously assess its reliability. (In the case of primary sources, I actively do so.) If I find that the source happens to be seriously flawed (rare on PubMed), I am never going to use it as a reference, either in Wikipedia or any other document. It would be unconscionable to do so.

Given your endorsement of Morgan's article based on the current version of WP:MEDRS, I believe that WP:MEDRS should be changed. A caveat should be included to the effect that "seriously flawed sources should be avoided". The prohibition of detailed peer review should be removed.

" I think it extremely important to address efficacy somewhere in this article. "

Okay, that's fair enough. Personally, I am not as strongly opinionated about this, but I do think that it would be useful to discuss efficacy.

" And while I see several people saying that if they wrote this paper, they would have made different choices about what to include in it, I don't see anyone suggesting better sources (do they exist?) or trying to provide better information to our readers. "

I haven't (yet) done a search for other sources. We all busy with other articles and real life. I am so shocked by Morgan's paper that this must be dealt with first.

" Can we try to actually solve this problem and get information to the reader, rather than just complaining about these authors' peer-review-approved choices? "

There is a more fundamental problem with WP:MEDRS that is technically more important than the choice of reference for this article. Axl ¤ [Talk] 11:22, 23 April 2012 (UTC)


  • Erm, no good holding our breath for some other sucker to address such an unfocussed research question. If the source is the only one out there, does that mean it has to be given infinite relative weight (even if its absolute weight is rather low)? The idea of reintroducing the Efficacy section worries me more than somewhat — anyone who googles chemotherapy finds this page on top of the pops.
    MistyMorn (talk) 15:45, 23 April 2012 (UTC)
  • Er, I don't think citing this paper in terms of what it actually attempted to suggest, will do much harm. The authors suggest that national health systems should worry less about getting cytotoxic chemo (CC) to everybody with a solid tumor for whom it is indicated, and perhaps worry more about making sure that people get the best standard of care treatment with other modalities (surgery, radiation). Sure, these are probably radiation oncologists who feel short-changed-- they didn't get their wazoo conformal beam machine, but they see the government buying Taxol for everybody. So they sit down and try to figure out why the onc guys get all the money. And what the impact would be on cancer survival if CC were to entirely disappear and wasn't available to anybody with a solid tumor at any stage for which it was indicated and had been claimed to increase 5-year survival. Even taking all the studies of this type at their word, on how well CC works. And they find that having chemo available in a country's arsenal for oncologists (vs. hem/onc people, who aren't counted), only increases the 5-year survival for solid internal tumor patients, on the whole, by 2 or 3%. They imply that the 60% of cancer patients who do survive to 5 years after diagnosis are cured by other modalities, but it's not clear if this denominator includes the leukemias and lymphomas. It would have been a much more interesting paper if it had, since then it really would have addressed the question of what a country should be spending on CC.

    I mean, suppose we find out that radiation therapy is responsible for 10% of the solid tumor cures (or 5 year survival or whatever proxy you like), and yet Australia is spending twice as much money on CC than on updated radiotherapy. That would wind your clock, would it not? Of course, if you're a patient looking to get chemo, it's not very helpful, since you are bound to have more information on yourself and your situation than is presented here (as has been pointed out). But it would be interesting to know if CC only saves no more than 1 person in 30 of all those who it is clearly indicated for, as a survival-treatment claim. That's starting to look like statin statistics-- how many people do you have to treat with statins, for whom they are indicated, in order to save 5 patient-years of life. Is it 10? 30? 100? 1000? At some point the cost, hassle, and side effects take it out. Of course, there are people who think that a $50,000 treatment should be used on anybody if it has only a one in a million chance of getting them another 5 years, or perhaps even it only extends life by 2 months like Erbitux for stage IV colon cancer. BUt governments have opportunity costs, and they know that that money has to come out of somebody else's medical care. SBHarris 01:56, 3 May 2012 (UTC)

The authors explicitly did not include leukemias; they also excluded clinical outcomes in patients under 20 years of age—and thereby threw out two groups that tend to have among the greatest five-year survival benefits. The other issue is whether we should be using five-year survival as a synonym for 'efficacy'; if CC gives patients with advanced disease a median of two years rather than one, that's a real and tangible benefit that won't necessarily be reflected in the five-year survival numbers. The authors explicitly acknowledge that "Our analysis does not address the effectiveness or survival contribution of cytotoxic chemotherapy in the palliative or non-curative treatment of malignant disease...". However bold or biased the paper's authors might have been, they very carefully avoided the use of the word 'efficacy' in their conclusions. TenOfAllTrades(talk) 03:26, 3 May 2012 (UTC)
Everybody has to choose a metric-- this is the one these people chose. Whatever metric you choose, there will be somebody else opining that you should have chosen a different one (and written a different paper than you did). These people were looking at 5 year survival and solid tumors. Had they looked at leukemias or life span prolongation, they doubtless would have gotten different numbers. Still, their answer to the question they asked, is interesting. If you asked the average patient, indeed the average physician, perhaps even the average oncologist, "What fraction of all adult patients with a new diagnosis of a solid tumor can in theory, using the guidelines of previous survival studies, have their lives saved by chemotherapy?" you probably would get a number somewhat higher than 3%. And I really doubt if quibbles over whether 5 year survival rather than 10 makes a big difference in this answer, as only one of the 20+ cancers surveyed was breast, and the difference with breast isn't large enough to affect all the rest.

Now, what fraction of adults with a diagnosis of a solid tumor at any point in their lives end up GETTING chemotherapy? A lot more than 3%. Most chemo is given not with a view to assistance with cure, but "palliatively." Some fraction of that non-curative treatment is given even without very good evidence that it palliates, let alone extends life. And of course there is some fraction of patients who live a little longer, but the extra time they get, is spent with worse quality.

All of this bears on the question of how CC is used in the medicine of industrialized (see "rich") countries. On the one side, you have patients who psychologically do not want to admit "giving up" and not "fighting", and on the other hand you have oncologists who make a large fraction of their salaries by marking up the CC they buy and give (you know that, right?). And who want to please their patients. So they "offer" CC with no promises. Or they do little n=1 experiments ("let's see how you feel..."). (If the alternative medicine people did that with something that destroys your neutrophils, and might be working by placebo effect, modern medicine would absolutely throw a fit). In any case, this all creates a huge incentive to do something other than evidence-based medicine on both sides of the therapeutic fence. It would be astonishing if that had no effect on practice, don't you think? And in my own experience in medicine these last 30 years, it certainly does. The old saying that coffin nails and casket locks are there to keep oncologists from continuing to administer chemotherapy, has quite a lot of bite to it. SBHarris 17:20, 3 May 2012 (UTC)

Merge Antineoplastic into Chemotherapy

Now that it appears (from the discussion above) that this article should be THE article for the subject of cancer chemotherapy, it seems like the content in Antineoplastic should be merged to here. As it seems, the only information in Antineoplastic that is not found in Chemotherapy is a more detailed list of drugs fitting into Chemotherapy#Cytotoxic antibiotics (L01D). Mikael Häggström (talk) 13:10, 18 May 2011 (UTC)

I performed the merge now. I left out some that was unreferenced and probably duplicate of already existing information here, but I welcome anyone to check if I forgot something important. Mikael Häggström (talk) 06:33, 22 May 2011 (UTC)

Move/rename page to "Cancer chemotherapy"

The following discussion is an archived discussion of the proposal. Please do not modify it. Subsequent comments should be made in a new section on the talk page. No further edits should be made to this section.

No consensus to move. Vegaswikian (talk) 01:54, 24 May 2011 (UTC) Relisted. Vegaswikian (talk) 01:54, 24 May 2011 (UTC)

ChemotherapyCancer chemotherapy – - I think this page should be named "Cancer chemotherapy", because its content is almost exclusively targeted at this subject, and we need a specific page for the subject of "cancer chemotherapy". Although some define "chemotherapy" as "cancer chemotherapy" ([64] Gale Encyclopedia of Medicine, The American Heritage® Medical Dictionary), others define it as any treatment with chemicals, including antibacterial ([65] Dorland's Medical Dictionary for Health Consumers, The American Heritage® Medical Dictionary, Mosby's Medical Dictionary, Miller-Keane Encyclopedia and Dictionary of Medicine, Saunders Comprehensive Veterinary Dictionary). So "Chemotherapy" could instead be made a disambiguation page or an explanatory stub with links to "Cancer chemotherapy" and "Antibacterials". The Antineoplastic article could be merged to "Cancer chemotherapy", but that can be done after this move - I think a major reason that few people have expanded the "Antineoplastic" article is the confusion whether any such additions should be to the "Chemotherapy" article or not, which this move will make clear. Mikael Häggström (talk) 05:34, 17 May 2011 (UTC)

  • Move/Split the introduction section could be split off as the start of a general chemotherapy article, with the history and most of the article moved to the suggested location, with a new intro. 65.95.13.213 (talk) 10:33, 17 May 2011 (UTC)
  • Oppose; this is the treatment which is almost universally known as "chemotherapy", and this is the article readers will expect to see when searching for it. Add a hatnote to a new article on general chemotherapy if necessary, but this is clearly the primary topic. Powers T 13:52, 17 May 2011 (UTC)
Possibly, perhaps with a hatnote saying:
This page is about cancer chemotherapy. For other uses, see Chemotherapy/Archive 1 (disambiguation).
, and the introduction to this article also specifying that this is about cancer chemotherapy. It will be more evident after a merge of Antineoplastic to here. Any other suggestions? Mikael Häggström (talk) 16:44, 17 May 2011 (UTC)
  • Oppose: Agree with Powers. –CWenger (^@) 18:11, 17 May 2011 (UTC)
I agree too (but anyway:) I'll start the appropriate changes related to this alternative. Mikael Häggström (talk) 12:46, 18 May 2011 (UTC)
This move request is withdrawn by requesting editor.

Non-cancer chemotherapy

Non-cancer chemotherapy should never have been created. It is not a standalone concept, and the terminology can easily be discussed here. JFW | T@lk 20:20, 18 May 2011 (UTC)
I agree that the Non-cancer chemotherapy could be merged to this article, such as to a section named Older definitions of the term chemotherapy. Still, I want it to be made clear that the subject of this article is cancer chemotherapy, and not any other definition of the term chemotherapy. Mikael Häggström (talk) 05:40, 19 May 2011 (UTC)
Could you merge the content back, into the history section? Thank you. JFW | T@lk 06:23, 19 May 2011 (UTC)
Sure. However, many dictionaries still define chemotherapy as any treatment with chemicals (see Move/rename request above), so watchful waiting is still indicated for this case. Mikael Häggström (talk) 08:23, 19 May 2011 (UTC)
The above discussion is preserved as an archive of the proposal. Please do not modify it. Subsequent comments should be made in a new section on this talk page. No further edits should be made to this section.

I've rewritten the lead to take care of all this, plus put in the elephant in the room, which is that by "chemotherapy" we really mean "cytotoxic drugs" (which now redirect here anyway). Understood in that sense, it's easy to explain what we mean by this word, and to qualify it when used in other senses. Read what I've written before you quicky revert me. I think I have it more or less right, if I do say so myself. Humbly yrs, SBHarris 23:41, 27 October 2012 (UTC)

I've tried to develop this a bit [66]. —MistyMorn (talk) 00:06, 28 October 2012 (UTC)
That's okay, although it commits us to the dubious view that you can't call it chemotherapy unless you're treating cancer. Some people would agree with this, and others not. The better agreement is that the agents remain chemotherapeutic agents even when not used against cancer. The way the lede is written now, chemotherapeutic agents are sometimes used in disease therapy that isn't "chemotherapy." Which is a bit weird logically, even if I can't fault it colloquially. SBHarris 00:16, 28 October 2012 (UTC)
Anyhow, I think we're getting there... A longstanding unaddressed conflict in the wording is now largely addressed, imo. And good leads never come easy anyway. Cheers! —MistyMorn (talk) 00:41, 28 October 2012 (UTC)
I don't think that "chemotherapy == cytotoxic drugs" is fair. That defines chemo regimens like CHOP-R as being non-chemo, because steroids and antibodies aren't cytotoxic. There are a lot of medications normally considered "chemo" because they are drugs used to treat cancer, but that are not cytotoxic. WhatamIdoing (talk) 02:16, 31 October 2012 (UTC)
Originally I said that a chemo regimen was defined by having at least one cytolytic drug (chemo drug). CHOP-r has 3 out of 5. If it had none it wouldn't be considered chemo. However, as it is, it is. The regimen is defined by its nastiest agents. The regimen is a chemo regimen. This doesn't mean every component is. SBHarris 08:59, 31 October 2012 (UTC)

Cannabis for nausea?

Why is there no discussion or even a link to using cannabis to minimize nausea and increase appetite? — Preceding unsigned comment added by 99.108.126.58 (talk) 18:52, 4 September 2011 (UTC)


Agreed, a section should be added under the side effects as an effective treatment. — Preceding unsigned comment added by 203.217.21.124 (talk) 02:17, 6 February 2012 (UTC)

It's addressed in Chemotherapy-induced nausea and vomiting, which is the place for specific treatments like that. WhatamIdoing (talk) 21:20, 29 March 2012 (UTC)

Treatment-induced resistance

I think the Adverse effects section should mention the Writing Treatment-induced damage to the tumor microenvironment promotes prostate cancer therapy resistance through WNT16B published in Nature Medicine on 05 August 2012 which had some resonance in the media (e.g. BBC).

It altredy exists a well sourced wiki related to this topic, WNT16, which should be linked too. Enaki (talk) 10:13, 18 September 2012 (UTC)

This requires secondary sources. Please provide some. JFW | T@lk 21:48, 27 October 2012 (UTC)

More primary research

The following was added:

This seems an ongoing avenue of research, but requires a secondary source to be suitable for inclusion in an encyclopedia. Please provide one. JFW | T@lk 21:48, 27 October 2012 (UTC)

  1. ^ G. Bertolini, L. Roz, and L. Roz, “Highly tumorigenic lung cancer CD133+ cells display stem-like features and are spared by cisplatin treatment,” Proceedings of the National Academy of Sciences of the United States of America, vol. 106, no. 38, pp. 16281–16286, 2009.
  2. ^ S. P. Hong, J. Wen, S. Bang, S. Park, and S. Y. Song, “CD44-positive cells are responsible for gemcitabine resistance in pancreatic cancer cells,” International Journal of Cancer, vol. 125, no. 10, pp. 2323–2331, 2009.
  3. ^ S. J. Dylla, L. Beviglia, and L. Beviglia, “Colorectal cancer stem cells are enriched in xenogeneic tumors following chemotherapy,” PLoS ONE, vol. 3, no. 6, Article ID e2428, 2008.
  4. ^ M. R. Loebinger, A. Giangreco, and A. Giangreco, “Squamous cell cancers contain a side population of stem-like cells that are made chemosensitive by ABC transporter blockade,” British Journal of Cancer, vol. 98, no. 2, pp. 380–387, 2008.
  5. ^ Q. Zhang, S. Shi, Y. Yen, J. Brown, J. Q. Ta, and A. D. Le, “A subpopulation of CD133+ cancer stem-like cells characterized in human oral squamous cell carcinoma confer resistance to chemotherapy,” Cancer Letters, vol. 289, no. 2, pp. 151–160, 2009.
Well, I agree that it's not (for Wikipedia's purposes) an ideal way of supporting the claims, but I think the claims are actually WP:Verifiable, and they might well be WP:DUE. WhatamIdoing (talk) 23:24, 27 October 2012 (UTC)
Whether DUE or UNDUE depends on what is inferred from this and implied by use of it. I think everybody believes that chemo has less effect against stem cells and that's why it's not more often curative. So what? This is not a "problem" (in the sense of making things worse), but more of a failing in the sense that we all wish it was better, and this is one reason why it is not. But stem cell effects do not speak to the real issue of whether chemo is (or isn't) better than nothing. If we think the surviving stem cells are now super stem cells made into Mighty Hulk Stem Cells by the chemo, let's see your evidence. We find out if chemo is better (or worse!) than nothing by doing clinical trials with proper non-treatment controls. All suggestions that it may be worse than nothing, based on dubious mechanistic arguments such as those above, need to be clinically verified. To use them to suggest anything like what I (think) is being suggested, is indeed WP:UNDUE and also WP:OR, WP:SYN, and WP:WRONGINFERRANCEDUMMKOPF. SBHarris 23:55, 27 October 2012 (UTC)
Meta-analyses are limited to specific kinds of malignancy and specific drugs, so it's extremely difficult to make general claims. However, I've added the two sentences (cited above) after reading an article about head and neck carcinoma, saying that chemotherapy is not effective in this group and thus is discouraged. This seems to be common knowledge among oncologists now. Thus I probably should have added that the risk depends on the type of cancer and is high e.g. in head and neck carcionmaSylwia Ufnalska (talk) 07:43, 28 October 2012 (UTC)
I wouldn't even regard chemo as worthless in head and neck cancer. It has shown a survival benefit when used concurently with radiation (chemoradiation, like RADPLAT). See here. Where chemo doesn't seem to do much good in head-and-neck is when used by itself, either before or after radiation. Assuming squamous cell tumors (remember that head and neck cancer is treated as a separate modality not due to tumor type, but simply because vital structure are crowded so closely together that simple wide resection as is done in other places, is often not an option). SBHarris 02:37, 29 October 2012 (UTC)
For what it's worth, I regard the statement as obvious, indeed almost self-evident—at least for anyone who has any experience or knowledge about cancer. Axl ¤ [Talk] 10:09, 28 October 2012 (UTC)
Wikipedia articles are intended for those who do not have sufficient knowledge of a subject, rather than for experts.Sylwia Ufnalska (talk) 18:27, 28 October 2012 (UTC)
Of course. My point is that the statement shouldn't be controversial at all. A basic reference to establish verifiability should be enough. Axl ¤ [Talk] 18:31, 29 October 2012 (UTC)
I think that SBHarris' worries are about "what is inferred from this". We aren't trying to infer anything. This isn't "so don't bother with the treatment your oncologist recommends, because it won't work"; the statements are more like "Hey, guess where those treatment-resistant cells come from". I think we should include the idea, perhaps minus the "problem" wording. WhatamIdoing (talk) 02:12, 31 October 2012 (UTC)
Ah. In that case, I throw "WP:WRONGINFERRANCEDUMMKOPF" [sic] back at SBHarris. Axl ¤ [Talk] 10:54, 31 October 2012 (UTC)

RE: link removal from Chemotherapy#Delivery

This is the edit in question. Section is concerned with methods of delivery, not oral care. If we were to cover oral care, I suggest adding content to Chemotherapy#Adverse_effects instead from a more authoritative source such as the NIH. Wafflephile (talk) 18:21, 15 February 2013 (UTC)

Costs

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

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

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)

Dosage

I added some more information to the "Dosage" section. Thank you for reviewing. And thanks for helping with my formatting!!! News Team Assemble![talk?] 03:11, 28 April 2014 (UTC)