Factors associated with utilization of nonproven cancer therapies in Turkey. A study of 135 patients from a single center.

In their search for a cure, a significant number of cancer patients use nonproven treatment (NPT) methods. However, little is known about patient and disease characteristics associated with the use of these methods. In this trial, we evaluated the prevalence of and the factors associated with the usage of nonproven cancer remedies in a teaching hospital in Turkey. A self-administered questionnaire was given to 135 cancer patients attending the outpatient clinics of a medical oncology department. Patients' demographic data, their usage of nonproven methods, and possible contributing factors were explored. Our cohort mainly comprised poor patients with only primary school education. Overall, 50% of our patients had used or were using NPT methods. Medicinal herbs (mainly stinging nettle) were the most frequently used remedy. In contrast, such "complementary therapies" as exercise, relaxation, and meditation were not employed. In multivariate analysis, only duration of disease was found to be significantly associated with NPT utilization [P=0.05, relative risk (RR)=1.94]. In addition, patient education level was marginally significant (P=0.07, RR=0.36). Apart from long duration of disease and being better educated, no other clinical, social, economic and cultural factors evaluated were associated with the use of NPT in our group of Turkish patients. Since these treatments are sometimes costly and have questionable efficacy and toxicity, proper scientific trials are needed to clarify whether such methods have a real role in cancer management.

Computed tomography 21 days after chemotherapy, three-dimensional estimates of metastatic volume and the need for surgery in patients with germ cell cancer.

OBJECTIVE: To assess whether the response visible on computed tomography (CT) 21 days after the first course of chemotherapy in patients with nonseminomatous germ cell tumour predicts the need for surgery and whether three-dimensional (3D) reconstruction adds to the diagnostic accuracy. PATIENTS AND METHODS: CT scans from 52 patients treated with cisplatin-based chemotherapy were assessed for tumour shrinkage by measuring the changes of a one-dimensional (1D) measurement of the maximum transverse diameter, and comparing CT scans before, 21 days after the first course and at the end of chemotherapy (1D method). In a subset of patients, using a special formula, the 1D-derived 2D and 3D shrinkage (2Dder and 3Dder) were compared with four other computed or calculated methods (1D, 2D, 3Dcalc, 3Dcomp). RESULTS: At day 21, in 32 of 52 patients (62%) there was < 50% tumour shrinkage using the 1D assessment; 21 of them (66%) needed surgery, compared with none of the 20 patients with > 50% tumour shrinkage by day 21 (chi2 = 22.83, P < 0.001). The 1D method showed significantly less shrinkage than all the other methods but when this was used to derive a 3D shrinkage, assuming the mass to be spherical (3Dder), it was not statistically different from that of 3Dcomp. CONCLUSIONS: The assessment of the response from 1D CT scan estimates 21 days after initiating chemotherapy identifies a subgroup of patients who have a high probability of needing surgery. Although expected to be more accurate, the 3Dcomp estimate of tumour shrinkage was no better than the 3Dder estimate.