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European Journal of Cancer: Highlights of Issue 39:03

Translation, Compliance, Standardisation, Measurement, Validity, Finance: Major barriers to overcome in QOL research

Focus on QOL

In this issue Bottomley and colleagues outline the key challenges faced, progress that has been made and future strategies in Quality of Life (QOL) studies in a Position paper by European Organisation for Research and Treatment of Cancer (EORTC). These challenges include validity, translation, compliance, standardisation in design and measurements and financial support. Typically, trials including QOL measurements are phase III randomised trials and it is generally a secondary endpoint. The number of such trials has increased considerably in recent years. Approaches that the EORTC has implemented to overcome some of the aforementioned barriers to QOL research include monitoring, providing feedback, education, training and planning. The authors hope that with ongoing initiatives “all EORTC QOL studies will significantly impact upon the future treatment and care of patients”. Two other articles on QOL by Patrick and colleagues and Conroy and colleagues are also published in this issue.

Ralitrexed shows activity in malignant plueral mesothelioma

In this issue Baas and colleagues report that raltitrexed (TomudexR) has an activity exceeding 20% in chemonaive malignant pleural mesothelioma (MPH) patients. The incidence of MPM is expected to rise and the disease is associated with a poor survival. For this reason, the EORTC have tested various single agents for activity. In a phase II multicentre EORTC study, Baas and colleagues examined the activity of 3mg/m2 of raltitrexed given 3 weekly as an intravenous bolus up to a maximum of 8 cycles (to 24 patients). 104 courses were given and 5 responses (20.8%; 95%Confidence Intervals 7.1-42.2%) were observed. Toxicity was mild. Raltitrexed is a quinazoline folate analogue and an inhibitor of thymidylate synthase. Interestingly, another inhibitor of folate metabolism (pemetrexed) has recently been reported to have activity in this disease. The authors conclude that “ further studies are warranted”.

The Chernobyl disaster-dispelling rumours and fears with facts

This is what Dr Rahu attempts to do in a review published in this issue. He describes the background to the disaster and the rumours and fears resulting from it, but states that only facts can dispel these. A recent review by UNSCEAR (United Nations Scientific Committee on the Effects of Atomic Radiation) attempts to do this. It states that although there is an increase in childhood thyroid cancers, there is no accredited evidence for an increase in leukaemias or for an increase in the overall cancer incidence and mortality associated with radiation exposure. Unfortunately, as pointed out by Dr Rahu, there are weak epidemiological structures in place in the three countries most affected that hampers the “search for the truth”. He concludes that a combination of political will to guarantee more money for research and international multidisciplinary effort will be required to learn more about the long-term effects of this disaster.

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