Side Effects: The shorter is better rule may also apply to one type of breast cancer therapy

The new rule in antibiotic therapy is the shorter the duration the better: “Every randomized clinical trial that has ever compared short-course therapy with longer-course therapy … has found that shorter-course therapies are just as effective.” And crucially, shorter courses reduce your risk of adverse side effects such as life-threatening allergic reactions, super infections, nausea and rash.

It turns out that this very same idea may apply with equal force to cancer therapy. NPR reports that a new study out of Cambridge University found women who were diagnosed with early-stage HER2-positive breast cancer did just as well with 6 months of treatment with the drug Herceptin (trastuzumab) as did women who received a 12-month course of this treatment. Specifically, survival was nearly identical after five years. And women with the shorter treatment also had fewer side-effects such as heart damage, fatigue and pain.

So why on earth would we be doubling up on treatment length when it doesn’t help and it exposes us to serious health risks and greater costs? NPR:

This kind of question — of whether the standard, established dose could be reduced to good effect — is one that drug manufacturers don’t go out of their way to answer once a drug is on the market, because the result could reduce the amount of drugs they sell.

The American Society of Clinical Oncology told NPR they found the Cambridge study “quite compelling” and “it is likely that it will signal a shift” in how doctors prescribe this drug to their early-stage breast cancer patients.

Here’s a brief video and accompanying article that nicely explain Herceptin therapy and HER2-breast cancer. Notice at the end of the video the long list of side effects that the drug therapy exposes you to. It’s precisely this that the ‘shorter is better’ mantra is trying to avoid.


How Herceptin Works: the Mechanism of Action from on Vimeo.

Doctors work under a lot of pressure and it can undermine their decision-making. The better we understand that pressure, the better our care.

Why would our best and brightest get it wrong half the time? As many as 1 in every 2 antibiotics prescribed in the U.S. are unnecessary or inappropriate. Is that because doctors are incompetent, or don’t care if they get it right? Or is something else going on?

That’s what researchers at the University of Pennsylvania wanted to know and so they went directly to clinicians and asked them. And what they found is that these “well-intentioned individuals” work under crippling emotional pressure which in turn drives poor decision making. Lead investigator Julia Szymczak, PhD:

One of the most common and repeated themes that occurred across the data … was … this constant emotional experience of fear; fear of something happening to the patient, fear of being wrong, fear of being sued. And to alleviate that fear they [doctors] said, ‘we use antibiotics to comfort ourselves.’

In the following video and accompanying article, Dr. Szymczak explains how the burden of caring for sick people when too often doctors don’t know what’s wrong, and providing that care under the watchful eye of colleagues, patients and their families, triggers a “very strong emotional reaction to do something.” And how that ‘something’ invariably translates into “quickly put[ting] a patient on a broad-spectrum antibiotic in an almost automatic and unquestioned way.”

Szymczak’s insightful work isn’t about blame; it’s a plea for understanding, premised on the idea that understanding begins the road to better treatment – writ large. Because her work immediately invites a crucial question: If the pressures she identifies are indeed systemic as the physicians themselves say they are, then shouldn’t we be asking if medical decision-making is being compromised across the board?


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