Systematic review of role of bisphosphonates on skeletal morbidity in metastatic cancer
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7413.469 (Published 28 August 2003) Cite this as: BMJ 2003;327:469All rapid responses
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Ross et al, in their review of the role of bisphosphonates in
metastatic cancer, recommend their use in all patients diagnosed with bone
metastases - irrespective of symptoms.
In a palliative care setting, there are several implications in
adopting this policy. Firstly, single dose zolendronic acid (Zometa)
currently costs £195.00 for a single treatment. Thus to commence all
palliative care patients on bisphosphonates, would have huge financial
implications for UK hospices - many of which have charitable funding.
Secondly, it is noted that there is little evidence available in
these studies that assess quality of life scores. Thus, in a symptom led
service such as palliative care, more evidence is needed before commencing
asymptomatic patients on an expensive, invasive treatment where an
improvement in symptoms and quality of life has not been clearly
demonstrated.
Competing interests:
None declared
Competing interests: No competing interests
Sir,
The article by McAlindon et al1 briefly highlights one of the
potential concerns of subjects recruited from the Internet. Clearly the
Internet provided a previously untapped recruitment resource. This is
especially in the case of rare diseases where several self-help groups may
now accessed to aid recruitment. However, it is difficult to know if those
who have access to the Internet or those who join self help groups are
systematically different to those who do not. In addition, for conditions
which occur predominantly in the elderly, technophobia may exist, so that
those elderly people who do answer may be a self selecting group who are
more motivated, thus leading to respondent bias.
Reference List
1. McAlindon T, Formica M, Kabbara K, LaValley M, Lehmer M.
Conducting clinical trials over the internet: feasibility study. BMJ
2003;327:484-7.
Competing interests:
None declared
Competing interests: No competing interests
A mistake in the Forest Plots
Dear Sir
This [BMJ 2003 327:469] paper was recently used in a critical
appraisal workshop run by CASP España (www.redcaspe.org). We found a
mistake in the Forest Plots: the line of "no treatment difference" is
labelled as zero on the X-axis yet the estimate and CIs show that the line
is (correctly) placed at 1.
The mistake is repeated in all the Forest plots and the paper would
better if this could be corrected.
Yours faithfully
Competing interests:
None declared
Competing interests: No competing interests