|
|
eLetters: More headaches for cancer care
In response to: Breast cancer survival by teaching status of the initial treating hospital
Brian P Higgins
Email: bhiggins@cvh.on.ca
Affiliation: Credit Valley Hospital Mississauga
Posted on: January 26, 2001
I am responding to your article by Chaudhry et al. Oncology is a difficult enough specialty to practise at the best of times but has now become even more challenging as a result of this paper. Despite acknowledging the many pitfalls of a retrospective analysis of a small number of both patients and events, they felt compelled to state that it would be advantageous for women with small tumours to be treated at teaching centers! I can't believe this type of research justifies its publication let alone its placement as the lead article inthe CMAJ. The teaching center cases tended to have more favourable characteristics, (Size, Grade, ER+, net income) although a multivariate analysis was performed. In addition it should be noted that in fact more women were treated with adjuvant systemic therapy in the community (38% vs 30%) than in teaching hospitals. Despite the resources supposedly available in teaching centers, more cases were reported as ER missing! (21% vs 15%) I know of no literature that closer or more intense surveillance leads to improved survival in breast cancer patients. How the authors draw conclusions from this study that have such far reaching clinical implications is distressing!!!
Copyright 2000 Canadian Medical Association or its licensors |
Canadian
Medical Association Journal