Guest guest Posted March 2, 2008 Report Share Posted March 2, 2008 Greetings, Patients may sometimes fear that reporting symptoms will lead to defensive medicine - favoring the initiation of what may be unnecessary tests and interventions. Being human, we also tend to delay actions that will be unpleasant. So we might conclude that we have a bias in favor of delaying actions and under-reporting symptoms - a reason dentists routinely call to remind us our next appointment. I think this tendency of delay and avoidance is also a factor contributing to low participation in clinical trials, because if you wait to the last minute to treat - when there's an urgent need for a fast response - your options will be limited to the tried and true. Also, it may be that some therapies are likely to work optimally in less advanced stages of disease, such as monoclonal antibodies, RIT and immunotherapies. Clearly, for indolent lymphomas watchful waiting (a time to observe without action) is a good idea, but there is also a time in which treatment is imminent but not yet necessary as evidenced by lab trends and steady progression. This window of time, when treatment appears imminent but is not yet required, we might call a Treatment Window of Opportunity (TWO). Seems to me that the TWO provides an opportunity to choose from among the *full range* of treatment options, including investigational. The advantage of recognizing TWO and acting at this time is that we gain control about the approach to treatment, and if we participate in a trial we may benefit early from new approaches to treatment while helping to make progress against the disease. For example, within TWO a lower-risk therapy might be tried - and given time to work - and there will still be time to change the approach if needed. Ideally, such probing first therapies will be of a type that are unlikely to burn treatment bridges - targeted therapies perhaps, or immunotherapies. ~ Karl Quote Link to comment Share on other sites More sharing options...
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