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Brain Tumor Treatment Guidelines Not Always Followed

Chemotherapy, antidepressants underused, study says

TUESDAY, Feb. 1, 2005 (HealthDayNews) -- Many oncologists who treat patients with brain tumors are prescribing anti-seizure medications too often while not using antidepressants and chemotherapy enough, researchers report.

The findings indicate that some oncologists don't follow national guidelines about the treatment of the most dangerous types of brain cancer, said study co-author Dr. Susan M. Chang, a neuro-oncologist at the University of California, San Francisco.

However, the tumors are very rare, she added, and doctors may only see a few cases a year. "I'm not pointing fingers and saying that the doctors aren't doing their work," she said. "It's just a challenge."

The findings appear in the Feb. 2 issue of the Journal of the American Medical Association.

An estimated 18,000 Americans develop primary brain tumors each year, meaning the cancer appears first in the brain, Chang said. For almost all patients with spreading cancers, the prognosis is grim: only about 5 percent survive for five years, and doctors don't use the word "cure."

The tumors are "very resistant to treatment, radiation and chemotherapy," Chang said. Even when doctors manage to shrink the tumors, microscopic remnants remain and often grow back within a few months, she said.

In the new study, Chang and her colleagues looked at a 1997-2000 survey of 565 newly diagnosed brain cancer patients.

Eight-seven percent had radiation treatment, but only 54 percent had chemotherapy, a commonly recommended treatment. The results raise questions about why chemotherapy isn't more popular, but the study doesn't provide answers, Chang said.

The researchers reported that their findings suggest a few other potential problems. For one, guidelines suggest that doctors shouldn't put patients on anti-seizure medications unless they actually have seizures. However, more than 80 percent of the patients were put on the drugs; only 30 percent reported seizures.

"That's a conflict with what we understand about how to manage these patients," Chang said. Considering that the drugs have side effects, "it's an issue of quality of life for patients -- putting them on yet another drug they don't need is not good," she said.

Conversely, the study results suggest that many patients may be missing out on drugs they might need -- antidepressants. Only 8 percent of the patients reported being on them.

It's not clear how many brain cancer patients are depressed, but Chang said the issue deserves further investigation.

In an accompanying editorial in the journal, an oncologist and a researcher called for a "major paradigm shift and substantial changes in treatment and research" regarding brain tumors.

Doctors need to embrace experimental approaches and improve communication between universities and private clinics, wrote oncologist Dr. Paul Graham Fisher of Stanford University and researcher Patricia A. Buffler of the University of California at Berkeley.

Another oncologist agreed, pointing out that while brain cancer remains extremely difficult to treat, there are options.

"It's very important that people look at the treatment recommendations as the essential minimum," said Dr. Robert Aiken, director of neurological oncology at Beth Israel Medical Center and St. Luke's Roosevelt Hospital Center in New York City.

More information

Learn more about brain tumors from the National Cancer Institute.

SOURCES: Susan M. Chang, M.D., neuro-oncologist, University of California, San Francisco; Robert Aiken, M.D., director, neurological oncology, Beth Israel Medical Center and St. Luke's Roosevelt Hospital Center, New York City, Feb. 2, 2005, Journal of the American Medical Association
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