PALLIATIVE CANCER-CHEMOTHERAPY

Recent data on cancer mortality call for a reallocation of resources f rom searching for new treatments of advanced disease to preventive str ategies. Vaccination against HBV or other infectious agents predisposi ng to cancer has been more successful than non-specific prevention e.g . with supplementary vitamin intake. The effectiveness of systemic che motherapy decreases with the number of tumour cells present and with i nherent drug resistance thus limiting palliative chemotherapy. Stringe nt criteria for duration or intensity of palliative treatment are ofte n missing. In contrast oncologic emergencies require immediate diagnos tic work-up and therapeutic intervention. Salvage chemotherapy is usef ul if lack of host tolerance, non-compliance, and insufficient dose in tensity have been excluded as causes of previous treatment failure in addition to analgesics, antibiotics, transfusions, and haematopoetic g rowth factors psychological support is needed along with palliative ch emotherapy. The loss of treatment efficacy with increasing number of t umour cells probably also holds true for new treatments now still in t heir infancy such as differentiation, immune attack or gene transfer. Despite the obvious need for a shift from palliative treatment to prev ention the establishment of quality standards for palliative chemother apy remains a major goal.