Chemotherapy, cancer, breast cancer, adjuvant

Chemotherapy: Right for Everyone Else

Chemotherapy: Right for Everyone Else

© 2009 Wellness Clubs of

Many years ago I read a thought-provoking editorial titled “Could We Afford a Cure for Cancer?” The author argued, quite convincingly, that the cancer treatment industry accounts for such a large percentage of the gross domestic product (GDP) of the United States that if a simple and effective treatment for cancer were to be discovered it would need to be suppressed and hidden from the public to avoid an economic collapse. Total health care spending at that time was approximately 10 percent of the GDP. Today it is closer to 16 percent.

I am not suggesting that a secret cancer treatment exists. I simply wish to point out that cancer treatment is big business. As such, there are huge financial incentives to see that individuals with a diagnosis of cancer receive “appropriate treatment” and disincentives to seek out or publicize measures that might dissuade individuals from pursuing that treatment. In most cases, “appropriate treatment” includes chemotherapy – the use of highly toxic drugs with the intent to kill enough cancer cells to bring about improvement without killing the recipient in the process.

I am not suggesting that cancer chemotherapy treatments are always inappropriate. There are conditions in which they may enhance the quality of life or even result in elimination of the cancer entirely. Cancers which respond favorably to chemotherapy include acute leukemias, Hodgkin’s Disease, intermediate and high-grade non-Hodgkin lymphomas, testicular cancer, ovarian cancer, and Wilms’ tumor of childhood. Response comes at a price; side effects of the treatment can be brutal. Most people will opt for treatment, but it is difficult to criticize those individuals who do not wish to receive it.

What I do wish to suggest is that in the management of most cancerous conditions chemotherapy does more harm than good. These are situations where cancer chemotherapy does not offer a reasonable chance of achieving a cure or ameliorating the effects of the tumor. In these cases administration of chemotherapeutic drugs can only lower the quality of the patient’s life. They may even cause the individual to die more quickly than had they not been given.

If cancer treatments were to be evaluated from a humane perspective several questions would be asked. Unfortunately, they are not generally considered when treatment regimens are evaluated. For a particular chemotherapy drug or combination of drugs to be considered “effective” it need only demonstrate that it brings about a response when administered. A response is defined as shrinkage of the tumor that is present. The tumor need not disappear, it does not need to shrink dramatically, the response does not need to be prolonged, and the results do not need to be consistent. An initial reduction in tumor size, however small, is deemed sufficient evidence that the drug or drugs should be administered to everyone who presents with the cancer in question. If appropriate questions were asked, and honest answers were given, chemotherapy would be restricted to the handful of conditions listed above in which it has shown clear benefits. For other conditions it would not be considered a serious option.

The first question that should be asked about a cancer treatment is “Does the proposed treatment offer a reasonable chance of curing the disease?” The fact that the word “cure” is almost never used in cancer treatment settings should be a clue that the most common answer to this question is “no”.

The second question to be asked is “Will the proposed treatment extend the life of the individual to whom it is being administered by more than a few months?” Studies have shown that this is rarely the case outside of the specific conditions I have listed.

Another question that should be addressed is “Are serious side effects associated with the treatment regimen?” The answer is yes for nearly all forms of cancer chemotherapy. The most commonly reported side effects are nausea and vomiting, fatigue, loss of appetite, taste changes, and headache, but more severe reactions are often seen. Treatment can, in fact, be fatal.

Not all adverse effects of chemotherapy are physical. Rose Kushner, who became a cancer activist before dying of breast cancer, recognized that physicians are often blissfully unaware of the havoc their treatment regimens are creating. She wrote, “In the United States, baldness, nausea and vomiting, diarrhea, clogged veins, financial problems, broken marriages, disturbed children, loss of libido, loss of self esteem, and body image are nurse’s turf.”

There is an assumption in medicine that any treatment is better than no treatment. As a result there are few studies comparing cancer treatments to no treatment. Those that do exist are considered outdated. This is because the ethical committees that oversee medical research programs consider the use of chemotherapy obligatory. They would consider a study containing a control group of individuals who are not receiving a chemotherapy drug unethical and would not approve the study design. Not that it matters. Studies that failed to show a substantial benefit were ignored or given a positive spin to allow treatments to continue unabated.

Breast cancer is a prime example. Adjuvant chemotherapy - administration of chemotherapy following surgery or radiation even when there is no evidence of residual disease – has become routine. The justification for this, however, is very weak. Prior to the abandonment of placebo controlled trials (studies in which chemotherapy was compared to absence of chemotherapy) the benefits of chemotherapy were found to be negligible or non-existent. Only by manipulating the data was it possible to suggest that treatment was beneficial.

Two trials, the Guy’s-Manchester and West Highland studies, showed no benefit of adjuvant chemotherapy in the management of breast cancer. The findings were not taken seriously by an industry intent upon “proving” that treatment is effective. Chemotherapy advocates pointed to other trials, particularly the NSABP trial and the Milan trial to show that treatment was beneficial.

In both the NSABP and Milan studies, however, individuals who did not tolerate the treatment were dropped and not included in the final analysis. Twenty-two participants were excluded from the NSABP analysis and 29 were dropped from the Milan treatment group. Benefits were only seen in those subjects who were able to complete the full treatment. These comprised a mere 17 % of those enrolled.

It can be argued that chemotherapy in the NSABP and Milan served only to identify those individuals with the hardiest constitutions, those who were strong enough to complete the arduous treatment. By excluding those with less vitality from their analyses the researchers were able to artificially enhance their results; unnatural selection resulted in the survival of the fittest.

Another challenge with the conclusion that adjuvant chemotherapy should be offered to all women with breast cancer is that the benefits of chemotherapy were reported on the basis of “disease-free intervals” - the length of time until a recurrence was first identified. Analysis of the data from the controlled trials that were conducted before it became “unethical” to conduct them fails to demonstrate an increase in overall survival rate.

The best that can be said about adjuvant chemotherapy for breast cancer is that up to 3 percent of those receiving the treatment will benefit from a delay in the reappearance of their disease. There is no good evidence that they will survive longer than they would have without the treatment, only that their “disease free interval” will be slightly longer. 97 percent of those who suffer the toxic effects of chemotherapy will receive no benefit from it whatsoever.

Closely related to the “any treatment is better than no treatment” philosophy is the belief that “more aggressive is better”. Breast cancer is illustrative in this as well.

Women who are found to have cancer in four or more lymph nodes at the time of their initial diagnosis and treatment of breast cancer are at high risk for recurrence. When early chemotherapy regimens failed to produce any meaningful increase in survival, physicians turned to ever more aggressive protocols. By the 1980s a regimen of intense chemotherapy with bone marrow transplant was being offered.

The procedure involved obtaining bone marrow stem cells from the patient prior to breast cancer surgery. Following surgery the patient was given incredibly toxic, multidrug chemotherapy that was so destructive that it wiped out the body’s ability to produce blood cells. After completion of the chemotherapy regimen the patient’s stem cells were re-implanted in the bone marrow in hopes that cellular production would return.

Physicians were not alone in promoting intensive chemotherapy with bone marrow transplant in the management of advanced breast cancer. As breast cancer patients learned that the treatment was available they began to demand it. Insurer’s were reluctant to cover the over $100,000 cost of the unproven treatment, but a number of states passed laws requiring them to do so. It is estimated that over 20,000 women were treated in this manner.

Fortunately, while studies that withheld chemotherapy from one group of participants were no longer being allowed, it was possible to initiate trials comparing the intensive regimen to milder chemotherapy protocols. Oncologists expected the results to show an overwhelming advantage in survival in the groups receiving the intense treatment. Many patients agreed, for it was difficult to find women who were willing to enter the studies as a member of the group that received less aggressive treatment.

When the initial results were reported in 1999 there was shock and disbelief in the chemotherapy community. Four of the five ongoing studies were showing no benefit whatsoever. Only one study showed a slight improvement in cancer recurrence and survival. One of the studies, however, suggested that women in the intensive treatment group were faring more poorly. After twenty months of follow-up, 78 relapses and 25 deaths had occurred in the intensively treated group compared to only 55 relapses and 15 treatment-related deaths in the control group.

Oncologists quickly pointed out that the results were preliminary and that the benefit of intense treatment would appear over time. Others suggested that sub-groups of patients who would benefit from the procedure would emerge. Still others called for intensification of the intense regimen.

Time did not produce the anticipated results. Late in 2007 a thorough review of fifteen studies involving 6,200 breast cancer patients revealed that the intensive regimen provided no benefit over less aggressive approaches to any subset of study participants. This should shut the door on the use of intensive chemotherapy in breast cancer, but that may not be the case. Some cancer specialists argue that the failure did not lie in the intensity of the treatment but rather in failing to find the correct drug combination or in correctly defining the optimum interval between doses.

The results of chemotherapy in other solid tumors are generally unimpressive. A few studies have shown benefit in small subsets of patients, such as those who have colon cancer that has spread locally, but the belief that administering chemotherapy to cancer patients will improve survival remains unproven. For a detailed review of chemotherapy studies as they relate to specific tumors and patient subtypes I recommend the book Questioning Chemotherapy by Ralph Moss, Ph.D.

While I am not an oncologist and do not conduct cancer treatment trials I have been involved in the care of individuals with cancer for nearly forty years. Over that period of time I have made several observations.

I have been struck by the number of individuals who have initially refused chemotherapy, but who have ultimately accepted it because of intense pressure by family members and friends. I am amazed by how quickly and vehemently people insist that others submit to procedures they themselves would not wish to endure. That is why I subtitled this article “Right for Everyone Else”.

When people facing cancer consult with me I do not tell them to avoid chemotherapy. Doing so would be viewed by many in our society as an act of medical malpractice, but that is not the reason I remain silent. It is because I have learned that the most critical factor in determining whether or not someone will survive any health challenge, but especially cancer, is the degree of hope he or she possesses. Because it is promoted so heavily in our society, chemotherapy is a major avenue of hope for many. To tell individuals that they should not subject their bodies to the toxic effects of chemotherapy could destroy hope and have the unintended effect of speeding their demise.

On the other hand, whenever someone expresses a desire to avoid chemotherapy I support that decision wholeheartedly. I do not echo the advice of so many that to refuse chemotherapy is unacceptable. To the contrary, my experience has been that individuals who choose to aggressively deal with their cancer with changes in diet, lifestyle, nutritional supplementation, and electromagnetic supports routinely live longer with a much higher quality of life than those who allow themselves to be poisoned with toxic drugs.

This is particularly true of people who institute aggressive supportive measures as their initial response rather than turning to those measures after chemotherapeutic agents have destroyed or severely impaired the body’s ability to fight back. The attitude of “I might as well do everything that’s available; it can’t hurt” is naïve and dangerous. Once the body’s immune system has been damaged by the effects of chemotherapeutic drugs it rarely, if ever, regains its full capability. The significance of this must not be underestimated; cancer is first and foremost a disease characterized by a failure of the body’s immune system to stop the uncontrolled growth of damaged cells. Compromising immune function through the administration of toxic drugs rather than supporting immune function with appropriate supports is a recipe for failure. This is why the use of adjunctive chemotherapy (chemotherapy given after any identifiable tumor has been removed in an attempt to kill any cancer cells that may be elsewhere in the body) is an anathema to me.

The challenge in making wise choices when dealing with cancer is that some people will die of the disease regardless of how they choose to address the condition. If an individual accepts chemotherapy and dies as a direct result of that therapy it is considered an unfortunate consequence of pursuing the best option available. If an individual rejects chemotherapy and subsequently dies of cancer, even if the quality and quantity of their life exceeded that normally achieved with chemotherapy treatment, it is considered an unnecessary event that could have been prevented had only they received “appropriate treatment”.

Conversely, if someone receives chemotherapy and lives the treatment receives the credit for their survival. If someone refuses chemotherapy and survives they were “lucky” and should not be used as an example for others who wish to follow the same course.

There has never been, and there will never be a trial comparing the outcome of chemotherapeutic treatment for cancer to a comprehensive program of supporting the body’s intrinsic ability to fight cancer. There are a few studies looking at the supplementation of a few basic nutrients in cancer patients, but they are irrelevant. One cannot adequately address the challenges the body faces in fighting the advance of cancer in that manner. A comprehensive approach is needed.

Ten years ago I reviewed the mechanisms by which cancer develops and recommended steps that could be taken to address them effectively. Although there have been some advances in the quality of supports that are available, the basic principles remain the same.

It is important to address spiritual issues by drawing near to God and by activating prayer chains. One must resolve any issues that are generating feelings of anger, hostility, anxiety, or guilt and stop listening to radio programs, watching television shows or reading material that triggers those emotions. Rather, the person fighting cancer should watch, listen to, and read materials that are encouraging, uplifting and engender hope. In as much as it is possible one should avoid interactions with people who are pessimistic and seek out relationships with people who have an optimistic attitude and leave one feeling better for having spent time with them.

It is important to increase alkalinity in the body by eliminating animal protein from the diet and increasing consumption of fruits and vegetables. A high percentage of the diet should be comprised of raw foods. Salt at the table should be potassium chloride, not sodium chloride. Animal fat, which metabolizes to the damaging lipid peroxyl free radical should be avoided and comprehensive antioxidant supports should be consumed. The ratio of omega 3 to omega 6 fatty acids should be improved. A rich source of methyl groups should be provided to support repair processes within the body and the immune system should be supported. Electromagnetic issues should be corrected with devices that enhance the energy frequencies needed by the body for health and healing.

Whenever and wherever cancer appears, addressing the mechanisms that predispose to cancer development and growth should be the first step taken rather than the last. Additionally, I advocate surgical removal of the tumor if it is possible to do so without risking serious complications. If experience has demonstrated that local radiation significantly improves the outcome it should be considered as well. Chemotherapy is reasonable in those conditions in which there is a high likelihood that treatment will result in a cure, but it is unlikely to provide significant benefit in most types of cancer. The vast majority of those with cancer will not benefit from submitting to a course of chemotherapy; they will only compromise their body’s ability to fight back.

© 2008 Wellness Clubs of

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