Letter: Cancer treatment

Sir: Professor John Smyth is quite right to call for more cancer patients to be referred to major centres ('Cancer expert attacks 'cowboy' doctors', 1 December). Not only is there increasing evidence that patients treated at these hospitals have a better chance of survival, but in addition they are much more likely to be treated according to strict protocols, often participating in the clinical trials that are so important if we are to establish better treatments. Only this morning an important study from the Royal Marsden Hospital, one of our best treatment centres, has suggested that there might be an improved outcome in breast cancer patients treated with a novel type of infusional chemotherapy. Studies like this rely on a steady flow of patients in order to achieve proper confirmation of exciting preliminary results.

Large cancer treatment centres are accused of being more expensive on a 'per patient' basis, but the truth is that the quality of treatment tends to be better, and the patient far more likely to make a real contribution to future knowledge via protocol-guided clinical trials.

We are all potential patients, yet despite the generally poor results with cancer, only 10 per cent or fewer are entered on clinical studies. 'Patient power' should be encouraged; in my view the only way forward is through proper education of patients so they understand their right to be treated in the well equipped centre of their choice. After all, was this not the essential philosophy behind the newly commercialised health service?

Yours sincerely,

JEFFREY TOBIAS

Clinical Director

Cancer Services

UCH/Middlesex Hospitals

London, W1

2 December