ACP InternistMKSAP Quiz: Advice Before Beginning Chemotherapy Regimen

Some confusion remains when it comes to cure, overall survival, and progression-free survival.

A 73-year-old woman is seeking advice before beginning a new chemotherapy regimen for metastatic adenocarcinoma of the colon. She is currently feeling well, with minor tumor pain controlled with occasional use of ibuprofen and continues to work full time. The new chemotherapy protocol offers a modest progression-free survival benefit over a placebo but with increased toxicity.

According to the American Cancer Society, colorectal cancer is the third leading cause of cancer-related deaths in men and in women, and the second most common cause of cancer deaths when men and women are combined in the United States.

Question

Which of the following results can the patient reasonably expect with the new chemotherapy regimen?

• Greater probability of cure. Cure in oncology implies complete eradication of the cancer, with no further treatment required, and the patient living out their life without recurrence of that type of cancer.
• Improved quality of life. Quality of life is a complex metric that incorporates many physical and psychological aspects of a patient’s overall condition.
• Longer life. This refers to overall survival, which is the time from when a treatment is started until the time of patient death.
• Longer time without further cancer growth. This refers to progression-free survival, which is the time from when a treatment is started until the time that either the tumor progresses or the patient dies.

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