| Japanese Journal of Clinical Oncology | Pages |
Letter
Knowledge grows as it is shared
To the Editor:
I have been privileged to be able to spend two weeks visiting the National Cancer Center Hospital (NCCH) in Tokyo through the generous program organized by the Foundation for Promotion of Cancer Research (FPCR). I have had an opportunity to meet medical oncologists, radiation oncologists and surgeons from the NCCH and elsewhere. There are some fascinating cultural differences between people and different organizational approaches, which one comes across in the hospital. More striking, however, is the commonality that one experiences with colleagues. We share the goals of improving patient care and advancing the scientific basis of oncology. In addition, we used common terminology, as is internationally recommended, to discuss and assess the results of patient treatment.
The purpose of my visit was to review with fellow oncologists, developments in the chemotherapy and radiotherapy of non-small cell lung cancer (NSCLC). Lung cancer is now replacing stomach cancer as the most common cause of death from cancer in Japan and accounts for approximately 45 000 deaths annually. It is predicted that by the year 2015, it will cause the deaths of more than 100 000 males and 36 000 females annually.
Advances in medical oncology have included the introduction of new agents to treat patients with NSCLC. A meta-analysis in 1995 found that cisplatin chemotherapy resulted in an increase in both the median and 1-year survival rates, when compared with patients who received best supportive care only. The 1-year survival rate was increased with chemotherapy from 10% to approximately 20%. In a number of prospective randomized studies, the results of treatment with conventional cisplatin based combinations have remained the same while the combination of cisplatin with newer agents for NSCLC has further improved the response rates to approximately 40% and the 1-year survival rate to around 40%. Examples of such agents, which have undergone phase 3 studies, are gemcitabine, paclitaxel and vinorelbine. Information is accruing from Japan on the use of these agents, as well as CPT11, with a fresh and critical review.
Patients with locally advanced NSCLC, who are inoperable, have conventionally been treated with irradiation. The large majority of such cases have micro-metastases and nowadays such patients receive chemotherapy in addition to irradiation as this has been shown to increase their median survival and long term survival rate. Important work has come out of Japan on the bast way to combine these two modalities. In particular, it was shown that giving chemotherapy and irradiation concurrently was better than giving them sequentially. However, there still remain important questions to be answered such as the dose and fractionation of irradiation and the possible use of cytotoxics which are also radiosensitizers.
Any discussion of progress in combating lung cancer must include the importance of combating cigarette smoking. At present, approximately 50% of Japanese males and 20% of females smoke. Very strict anti-tobacco legislation is being introduced in South Africa at present, as has occurred in Australia and the USA. Smoking is, for example, to be banned in public places. One can be sympathetic to the discomfort that some anti-smoking measures might cause to smokers, many of whom would like to stop smoking but cannot as they are physically addicted to smoking. Nevertheless, the gain to general public health will be so large that these measures should be strongly supported.
A topic of interest was the assessment of quality of life in patients with lung cancer. This is now a formalized science with validated tests. A great help in the conduct of these tests is the availability of research nurses to distribute and collect the questionnaires. This might be more difficult in Japan where research nurses are not at present widely employed. It is pleasing to note that in all studies that I know of, the more active regimens have generally been associated with an increase in quality of life. This can be understood by the aggressive nature of lung cancer and the heavy dependence of the quality of life in patients with lung cancer on disease progression.
I thank all the staff members at the NCCH for being so considerate and using English when I attended case conferences and ward rounds. I have in turn learnt to introduce myself and my lectures in Japanese and have been picking up Japanese phrases. I have learnt a great deal and I hope that I was able to make a small contribution. Knowledge grows as it is shared. The program of the FPCR is of great value as it promotes the sharing of knowledge. New knowledge is also unpredictable - otherwise it would not be new. Insights can also come from unexpected sources. Increasing the pool of people who exchange ideas can only be helpful.
Raymond P. Abratt
Department of Radiation Oncology
Groote Schuur Hospital
Cape Town, South Africa
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Last modification: 27 May 1999
Copyright© 1999 Foundation for Promotion of Cancer Research.
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