The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies

Morgan GWard RBarton M.


Radiation Oncology Department, Royal North Shore Hospital, Northern Sydney Cancer Centre, Sydney, NSW, Australia.



Questions about the role of curative or adjuvant cytotoxic chemotherapy in improving survival in adult cancer patients are raised by the discussion surrounding the funding and accessibility of cytotoxic drugs.


In order to find randomised clinical trials reporting a 5-year survival benefit solely attributable to cytotoxic chemotherapy in adult malignancies, we searched the scientific literature. Australian cancer registry data and Surveillance Epidemiology and End Results data for 1998 were used to calculate the total number of newly diagnosed cancer patients for 22 major adult malignancies. The total number of patients who would benefit for each type of cancer was calculated as the product of (a) the overall number of patients with that type of cancer, (b) the percentage of patients in that type of cancer who would benefit, and (c) the percentage increase in 5-year survival attributable solely to cytotoxic chemotherapy. The sum of the absolute numbers demonstrating a 5-year survival benefit expressed as a percentage of the total number for the 22 malignancies was the overall contribution.


According to estimates, 2.3% in Australia and 2.1% in the USA, curative and adjuvant cytotoxic chemotherapy contributed to adults’ 5-year survival.


Given that Australia’s 5-year relative survival rate for cancer is currently over 60%, it is evident that cytotoxic chemotherapy has a negligible effect on cancer survival. A thorough analysis of the cost-effectiveness and impact on quality of life is urgently needed to support the sustained financing and availability of medications used in cytotoxic chemotherapy.