Scientific research is a challengeto the status quo. It is based onan innate desire to know moreor an assumption that improvementsalways can be made. In medicine, thistranslates into a perpetual impetus toimprove patient health outcomes andquality of life. In this regard, investigatorsoften question the wisdom of current clinical practice and testwhether alternative patient managementapproaches could be better.
Here are examples of just such efforts. A phase 2 study ledby Brian I. Rini, MD, of Cleveland Clinic, tested whetheractive surveillance (AS) can be an appropriate management strategy forpatients who have metastatic renal cell carcinoma (mRCC), for whomimmediate systemic treatment is usually recommended. As Dr Rinistated, the study demonstrated that a subset of patients with mRCChave slow-growing disease that can be managed safely using active surveillance,“which could spare them the inconvenience and debilitatingside effects of aggressive treatments for about a year, and in some casesseveral years, without worsening anxiety and depression.” The study,which was published in The Lancet Oncology, included only 52 patients,but the results, if confirmed by larger trials, could give clinicians anotheroption to offer selected mRCC patients, one that could delay systemictherapy and its adverse effects.
In another study, published in European Urology, PärStattin, MD, of Uppsala University in Uppsala, Sweden, and colleaguesdemonstrated that radical local treatment may decrease mortality inmen with very high-risk prostate cancer, for whom clinical guidelinesrecommend only androgen deprivation therapy (ADT). The study was asemiecologic population-based investigation, and, as Dr Stattin’s grouppointed out, the findings need confirmation in randomized controlledtrials. Still, their study may represent an important step forward inproviding these men with a possible way to avoid the complicationsassociated with ADT.
Lastly, in a study published in the Clinical Journal of the AmericanSociety of Nephrology, Matthew J. Oliver, MD, of Sunnybrook HealthSciences Centre in Toronto, and colleagues compared hospitalizationrates associated with assisted peritoneal dialysis (PD) and in-centerhemodialysis (HD) and found no significant difference.Assisted PD is a treatment option for patients who would like to receivedialysis at home but have significant barriers to self-care. Evidence thatthis modality can be a safe alternative to in-center HD could promoteits use among certain populations—such as the elderly—for whomtraveling to an HD center can be disruptive and inconvenient.At this point, these studies only offer the promise of better patientmanagement, but they also exemplify how advancements in medicinestem from researchers’ nonacceptance of the status quo.