World Science report (); an evidence-based treatment of patients
A 53-year-old cancer patient's condition, many doctors baffled.
The perennial smoking men continuous coughing a month, several pounds of weight loss. The inspection, he unfortunately suffering from lung cancer and bone lesions appear. Patients with lung cancer, has been transferred to the bone how do I do? can further checking operations? preoperative chemotherapy or postoperative chemotherapy? 28 October, held in Tianjin of China tumor academic conference, the Guangdong provincial people's Hospital this case gave rise to the participating doctor's fierce controversy.
With China rising incidence of cancer, more and more people may like the face of cancer patients with the same torments of destiny. According to the Ministry of health statistics, last year China city dwellers number one cause of death is death for malignant tumors, nearly a quarter of the total. Once ill patients and their families are most concerned about is the ability to receive appropriate treatment.
Guangdong provincial people's Hospital for the patients to take an "evidence-based treatment" policy, which is "each diagnostic measures, each treatment method has the best evidence in support." As the patient's condition is more complex, the hospital treatment in the formulation of programmes be cautious with the most new lung cancer research results, including abroad last year published clinical trial data.
Not every patient will have the opportunity to get this somewhat like the "special care" evidence-based treatment. Presided over the case discussion of Guangdong provincial people's Hospital Oncology Center Director, anti-cancer Association professional Committee Chairman Wu Lung cancer a dragon professor said: "many hospitals in the country, including some large hospital, the patient may be misdiagnosed. ”
Reporters from the recently concluded the fourth China tumor academic Assembly was informed that China's cancer therapy exists considerable arbitrariness and not normative, and get the code for the treatment of patients with less than half that many patients have not been correctly treated, not only economic burden, or even accelerate death.
There are no norms
Tianjin medical university affiliated hospital is the largest cancer research base. And many similar large hospital, the hospital admitted a lot from other hospitals go to cancer patients. However, according to the POH Sun save Professor, average weekly will find one or two so-called "lung cancer" in fact is inflammatory pseudotumor or tuberculosis.
"Many local hospitals just picture film, do not do pathology, cytology, blindly follow the treatment of lung cancer," said Sun save patients not only spend thousands on top of that, but also on unwarranted side effects from chemotherapy, the quality of life is very low. ”
Even some of the big city hospitals, diagnostic abnormal also exist.
For example, cancer treatment areas to achieve breakthrough in recent years, a number of targeted anti-cancer drugs have appeared, such as the treatment of chronic leukemia and gastrointestinal stromal tumors of Gleevec, the treatment of non-small cell lung cancer Iressa, etc. These drugs to treat certain receptors, the key DNA or proteins as the "target", like "precision guided" did target the cancer cells without harming normal cells. Targeted therapy in an target is found, otherwise not receive the expected results.
But Sun save sad to said: "some big hospital does not accurately detect targets, but they allow patients to take 20 million on a course of Gleevec. Target is not found, an arrow is shot out the, the patient's 20 million be thrown away, of course. They are bankrupt, House to eat this medicine! some patients and their families also have common misconception is that which most expensive drug, which is the best medicine. ”
Cancer treatment of the same everywhere. Sun save that for the same clinical staging of the same type of cancer, even if the status of physical function in patients with basically the same, "the hospital also has its own treatment methods, but often do not know a, b, c three doctors who approach better."
There are also some doctors feel free to grab and dispose of cancer patients. The "Guangzhou daily" running in September of this year's report said, Guangdong Dongguan a breast cancer patients after surgery, was dragged to a famous three-level hospitals digestion section chemotherapy and radiotherapy. Reasonably, breast cancer patients should not be admitted to digestion, but the assimilation for economic interests should enable patients to masquerade as gastric cancer patients. Patients in the first chemotherapy in an emergency, it was transferred to thoracic surgery.
The report also claims that cancer treatment with chemotherapy can often be seen too many times and so excessive treatment, "life cycle, chemotherapy is more than" the vast majority of life in cancer patients, "driven by the interests, many doctors will persuade patients with the more expensive chemotherapy drugs. Originally only needs to be done 6 times chemotherapy, but doctors tend to be 8 or more. "A website in reprinting the article even said," the doctor a cancer. "
Guangdong provincial people's Hospital, Professor Wu a dragon and do not agree to the current most cancer patients present over-treatment. He has worked on more than 100 cases from other provinces and go to the hospital for treatment of lung cancer treatment history do analysis and statistics. Statistics show that "the majority of patients do not present the problem of excessive chemotherapy," and "of course, for a small number of patients, excessive treatment exists".
Wu a dragon also said that cancer treatment of the trap includes both excessive treatment, including lack of treatment. Furthermore, he is particularly worried about patients who have no will to use the exact medical evidence of treatment practices, such as the overwhelming of Ganoderma lucidum cancer said, "this is over-treatment." In addition, there are many patients are misleading to accept modern medical treatment, and simply accept the TCM treatment or treatment Lake, "this youyi is serious treatment, or even murder."
New guidelines for diagnosis and treatment of cancer
In the "Guangzhou daily" running the report, the cancer suffered is not the root cause of the standard treatment is summed up in China at present there is no established standard treatment for cancer.
But a Ng said the Dragon, health
Operations and anti-cancer Association back in 1989 it has been jointly developed the common malignancy in code, and in 1998 launched the "new" version "as time constraints, these two specifications for lack of evidence-based medicine, plus a long time without amendments, to the people, in particular to understand history of young experts of impression seems to be no standard".
Tianjin medical university affiliated hospital Sun save professor said that domestic cancer treatment method of evaluation is not normative, even for the hundreds of thousands, even tens of thousands of patients, they will not be able to figure out which kind of treatment is more effective, naturally affect cancer cure rate. Abroad is very important large-scale multicenter randomized controlled trial, few hospitals in the same way in the treatment of patients, compared with other methods, in order to filter out the best option.
Therefore, Professor Zhongguoaizhengjijinhui Vice President of Sun Yan and Wu a long three years ago in CCTV discusses the issue of the standard treatment for cancer, calls for the introduction of the relevant treatment guide.
Among the many experts of the joint efforts of the Ministry of health, the Chinese Medical Association and anti-cancer Association jointly published by the end of last year, the clinical guidelines for the diagnosis and treatment, cancer sciences-including the most common malignant tumors. This year we have developed the Sun Yan lead the NCCN (United States comprehensive cancer network) breast cancer and non-small cell lung cancer: a clinical practice guidelines of the Chinese version, several major cancer Chinese version of the NCCN guidelines are also in the pipeline.
"Black and white, it cannot be said that the country has no specification. The most critical, is to let people and doctors work together to supervise the implementation of the guidelines. "Wu a dragon in his blog writes.
He also said that the spirit of evidence-based medicine in new cancer guide reflects the ratio between 1989 and 1998 specification "a giant step forward." However, the evidence data inside guide to the vast majority of research from abroad, "China is the lack of own research data, in the absence of any rules of the game."
Sun save also said that Western treatment options is not always suitable for China and China's national conditions. For example, there is one difference to cancer, liver cancer in China accounted for more than half of the world, and many of them are caused by hepatitis. "Therefore, we very much need for large-scale multicenter randomized controlled studies conclude that for the Chinese people's treatment plan. ”
In China, the tumor's five-year survival rate of less than 25%, even if such as Beijing, Tianjin and Shanghai City is also only 40%, while the developed countries like the United States is up to 68%. This situation may be China's cancer early screening delays, many patients with confirmed time has entered a very advanced stage. In addition, Sun save China in cancer treatment behind West 10 to 20 years, although many of the techniques we will, "but if no standard treatment, what's the use?"
Save in the Sun, no specification of cancer treatment for many reasons, such as a driver of economic interests, no balance throughout the medical standards, lack of implementation of the traditional standard treatment.
In addition, Wu a dragon that treatment of excessive or insufficient treatment of an important reason is that the traditional division of the treatment system and many disadvantages. At present, the domestic several large inserted all the way to a single disease, army surgeon, doctor, medical oncology and radiotherapy doctors, imaging company, pathologists, experimental researchers gathered in one Department, the common treatment of cancer patients, greatly improving the efficiency and effectiveness of the treatment.
Early this year, Guangzhou medical insurance sector and the Guangdong provincial people's Hospital Oncology Center agreement: in the Oncology Center of cancer patients, hospital treatment of Medicare cost 1.8 million. "Patients up to one year down can claim 20 million, treatment costs are basically is ensured by a dragon," Wu said, "Guangzhou Medicare dare we first signed up, but also believe that we are not going to mess around, is based on evidence-based medicine in the treatment. ”
This academic Conference of China tumors at the closing ceremony, UICC President Cavally (Franco Cavalli), Professor, Professor, MD, President Xu guangping anti-cancer Association, Chinese society of Oncology Society Chairman Hao Greek mountain Professor jointly signed "I hand fight cancer," the Declaration of Tianjin. Declaration intentionally emphasized in China's key cancer clinical management specification Guide, gradually cancer professional settings and tumor specialist admittance.
Signs of individualized treatment
When the domestic many hospitals still trapped in the treatment of cancer does not regulate the mire of, some hospitals have emerged individualized treatment of symptoms. In this Chinese tumor academic conference, Shanghai chest hospital Han Bo-Professor, University affiliated hospital Hao Greek mountain Professor, and Professor Wu a dragon etc group reported on their respective roles in cancer research of individualized treatment.
It was a long introduction, Wu cancer of individualized treatment refers to a "tailor-made", patients develop individualized treatment strategies.
He said that in recent years conducted large-scale clinical trials, clinical clearly a number of factors that can be used as prognostic factor, predictive factor. For example, if the patient's behavior and weight loss index is greater than a certain value, chemotherapy or radiotherapy in effect will be greatly diminished or even up to the reaction.
However, this is based on a treatment strategy in clinical factors, still not truly individualized treatment. "Each individual is unique, is that every individual has different unique gene," Wu said a dragon, "therefore, based on the functional genomics and Proteomics of individualized therapy for lung cancer, it is possible to let us design a specific patient, so far has the best effect and minimum side effects of treatment programmes. ”
For example, in the last 5 years in lung cancer research and the most important one, is found to determine targeting drug Iressa on Oriental crowd of female non-smoker adenocarcinoma patients most effective. Iressa of targets is the EGFR gene mutation, and Oriental crowd, female, non-smoking, adenocarcinoma of the four factors can be attributed to EGFR gene mutation. Therefore, profit
Microarray detection EGFR mutations in patients with lung cancer, lung cancer patients can be treated more individualized Iressa. "In recent years a large number of targeted drugs emerging, is clinical cancer individualized treatment of prelude. ”
In theory, individualized treatment can greatly reduce the costs of cancer treatment. For example, lung cancer and the overall efficiency of less than 50%, almost every two people on one of them is not valid. Wu a dragon says, if you anticipate a chemotherapy regimen for half the crowd doesn't work, you can on this half the crowd to abandon the treatment plan, "chemotherapy often require tens of such treatment costs not falling down?"
Wu a dragon and his colleagues have been inserted in the Guangdong provincial people's Hospital began to individualized treatment clinical trials research, based on DNA chip analysis of results, of non-small cell lung cancer adjuvant chemotherapy and prediction of drug resistance. At present, the chip is very expensive, detection time takes approximately on 80 million. But he wants to 5 years after the chip prices could drop to $, 10 years after the individualized medical can become part of routine medical care.
Wu a dragon said: "promotion of standardized treatment alone is not enough, the future of cancer treatment must be individualized. "However, he cautioned that individualized cancer treatment is still a long way to go, after all, laboratory and clinical research on small samples and clinical application also exist between the great divide.
