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The simple definition of a therapeutic protocol does not in itself guarantee the best chances for the patient. It should be correctly applied. In order to do so:

• a correct and efficient classification of the cancer of each patient should be performed with all the necessary methodological tools (biological tests, surgical exploration, clinical examination under anaesthesia…),

• treatment execution by competent physicians. The care team should therefore be formed around the patient,

• complete and utter respect of the protocol even if part of the treatment needs to be transferred to a more competent colleague. Accepting the limits of one’s own competence is the only ethical attitude possible

Some important criteria are needed to guarantee the care quality:

• A sufficient number of treated patients: a rare disease cannot be treated correctly everywhere and some patients should be addressed to regional or national specialists so that, at the regional or national level, a few teams can gain competence in treating such rare diseases. Treating less than 10 to 15 patients per year is insufficient for ensuring thorough medical practice and follow-up.

• Therefore, only a small number of specialised teams may be available for a very particular type of cancer (for instance, in France, only 3 or 4 teams are considered competent for the treatment of retinoblastoma). Having previously worked within such teams does not imply acquired competence. Only regular practice enables maintained expertise in any particular domain.

• Only strict follow-up of patients, in order to study their survival and their quality of life can offer genuine progress. The cancer team should therefore be provided with the necessary resources to carry out such follow-up: efficient secretarial services, regular follow-up consultations as well as letters to general practitioners are necessary. Any truly efficient medical team should have well-organised follow-up procedures to prove its genuine capacity for global patient care.

• The small number of patients (even if over 30 per year) treated by each team implies the common pooling of results among national or international study groups to enable valuable comparisons to be made. This is one of the main reasons behind the definition of a “common language” for diagnostic procedures, classification, description of technical acts and follow-up. Reciprocal confidence is reinforced through the practice of mutual audits between participating teams.

• The publication of results (annual activity reports, regular result reports) also becomes an ethical act directly related to care quality. The number of ‘lost’ patients when publishing results reveals weaknesses in follow-up procedures and the physician’s disregard to the value of his/her patient care.

• There is no active treatment without toxicity: unfortunately the absence of a precise description of such toxicity or its underestimation are very frequently noted in publications.

• Any efficient therapeutic procedure should be reproducible: an isolated good result (if not reproducible) is no real hope for the patient. Unfortunately, more often than not, it is due to poor patient follow-up of the patients or to an underestimation of the statistically gaussian characteristics of any biological phenomena (including treatment!).

• Poor results or negative trials should also be published with the same interest as positive results: thus helping to avoid pointless, unpleasant or painful treatment for many patients.

The wide publication of results in magazines aimed at the general public, the extraordinary characteristics of such published results, the multiplication of satisfactory but incomplete data, the early publication of premature data and the absence of communication of failures are observed daily and are often associated with scientific competition. They are not in the best interest of patients, and should be fought by patient groups.

They only gratify journalists, giving hope to desperate patients and encouraging them to travel far and spend endless money on ill-adapted or futile treatment. A few years (or even months!) later, these miracle remedies have often been abandoned and replaced by others which continue to enthuse our insatiable media.

Unfortunately, although ethical rules against charlatans do exist, they are never used against advertising publications by eminent professors.