It may be better to give chemotherapy _before_ breast cancer surgery

The just published Cochrane review article

Mieog J, van der Hage J, van de Velde C.
Preoperative chemotherapy for women with operable breast cancer.
Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005002.
PMID: 17443564 [PubMed - in process].
DOI: 10.1002/14651858.CD005002.pub2.
<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=1 7443564>
<http://www.cochrane.org/reviews/en/ab002102.html>
<http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005002/frame.html>
(free full text)

suggests that in breast cancer it may be advantageous to give
chemotherapy _before_ surgery. Below its sbstract:

"BACKGROUND: Currently, preoperative chemotherapy is the
standard of care in locally advanced breast cancer to achieve
local tumour downsizing in order to make surgery possible.
Since the early 1980s, the role of preoperative chemotherapy
in early stage (or operable) breast cancer has been the
subject of study. Potential advantages are early introduction
of systemic therapy, determination of chemosensitivity,
reduction of tumour volume and downstaging of surgical
requirement. Concerns exist about local control after
downsized surgery and the delay of local treatment in
patients with tumours resistant to chemotherapy. OBJECTIVES:
To assess the effectiveness of preoperative chemotherapy in
women with operable breast cancer when compared to
postoperative chemotherapy. SEARCH STRATEGY: The Specialised
Register maintained by the Editorial Base of the Cochrane
Breast Cancer Group was searched on 4th of August 2005.
SELECTION CRITERIA: Randomised trials comparing preoperative
chemotherapy with postoperative in women with operable breast
cancer. DATA COLLECTION AND ANALYSIS: Studies were assessed
for eligibility and quality, and data were extracted by two
independent review authors. Hazard ratios were derived for
time-to-event outcomes directly or indirectly using the
methods described by Parmar. Relative risks were derived for
dichotomous outcomes. Meta-analyses were performed using
fixed effect model. MAIN RESULTS: We identified 14 eligible
studies which randomised a total of 5,500 women. Median
follow-up ranged from 18 to 124 months. Eight studies
described a satisfactory method of randomisation.Data, based
on 1139 estimated deaths in 4620 women available for
analysis, show equivalent overall survival rates with a HR of
0.98 (95% CI, 0.87 to 1.09; p, 0.67; no heterogeneity).
Preoperative chemotherapy increases breast conservation
rates, yet at the associated cost of increased loco regional
recurrence rates. However, this rate was not increased as
long as surgery remains part of the treatment even after
complete tumour regression (HR, 1.12; 95% CI, 0.92 to 1.37;
p, 0.25; no heterogeneity. Preoperative chemotherapy was
associated with fewer adverse effects. Pathological complete
response is associated with better survival than residual
disease (HR, 0.48; 95% CI, 0.33 to 0.69; p, < 10-4). AUTHORS'
CONCLUSIONS: This review suggests safe application of
preoperative chemotherapy in the treatment of women with
early stage breast cancer in order to down-stage surgical
requirement, to evaluate chemosensitivity and to facilitate
translational research."


Comments about this review in the article

Chemotherapy more effective when given before breast cancer surgery
<http://www.eurekalert.org/pub_releases/2007-05/cfta-cme051007.php>:

"Giving chemotherapy to women with operable breast cancer
before they have surgery —not after — helps physicians pin
down the best treatment regimen and can reduce the extent of
surgery, according to a new systematic review.

Preoperative chemotherapy reduced chemo-related infections by
4 percent and the need for mastectomies by 17 percent when
compared to postoperative chemotherapy, found reviewers led
by Sven Mieog, M.D., of Leiden University Medical Center in
the Netherlands.

Mieog and colleagues looked at 14 studies that included 5,500
women with operable breast cancer. Half of the women received
preoperative chemotherapy and the rest received chemotherapy
after surgery.

The data revealed a higher cancer recurrence rate in women
who had chemotherapy before surgery, although this did not
affect survival rates, which were similar for both groups.

"Ten studies reported overall survival data on 4,620 women
involving 1,139 estimated deaths," the authors write. "There
was no detectable difference between preoperative and
postoperative chemotherapy."

The review appears in the current issue of The Cochrane
Library, a publication of The Cochrane Collaboration, an
international organization that evaluates research in all
aspects of health care. Systematic reviews draw evidence-
based conclusions about medical practice after considering
both the content and quality of existing trials on a topic.

One reason for giving chemotherapy first is to shrink tumors
before surgery, the researchers say.

Moreover, preoperative chemotherapy allows doctors to see if
a tumor is resistant to a particular drug and thus adjust the
dose or switch to another drug after surgery. The patient
might avoid toxic side effects while getting another chance
to receive appropriate systemic treatment, Mieog said.

After surgery, doctors can no longer gauge chemotherapy's
effect on tumor size.

"Concerns could be raised on the postoperative and thus
'blind' administration of chemotherapy to patients with
tumors resistant to a specific chemotherapy regimen," Mieog
said. "These patients will receive all chemotherapy courses
while only experiencing the harmful side effects."

Side effects such as hair loss, cardiac symptoms, nausea and
vomiting, and white blood cell disorders were similar for
both groups, the Cochrane reviewers found.

"Initially, preoperative chemotherapy was set up to improve
overall survival by not waiting for the surgical procedure
and the subsequent recovery — a couple of months means one or
two [cancer] cell divisions," Mieog said.

He added, "The chemotherapy also increased the breast
conservation rate; it is well known that conserving the
breast as compared to mastectomy is associated with an
increased recurrence rate, without, however, hampering long-
term overall survival."

"It is important to evaluate issues of timing and
specifically consider the advantages of preoperative
chemotherapy," said Terry Mamounas, M.D., medical director of
the Mount Sinai Center for Breast Health in Cleveland.

Earlier studies suggest "a correlation between tumor response
with preoperative chemotherapy and relapse-free survival,"
Mamounas said. He added that the response to preoperative
chemotherapy can give clues about the outcome of the therapy
and help guide further treatment.

The Cochrane review showed that tumors shrank more in some of
the women who received preoperative chemotherapy than in
others. "Different factors could have influenced the reported
rates," the researchers write, "including definition of
response, blinding of assessor, method and type of
assessment, study population and type of chemotherapy used."

"The most appropriate method of clinical tumor response
assessment remains a matter of debate," they add.

The researchers say that preoperative chemotherapy is
currently the standard of care in locally advanced breast
cancer. The choice of whether women should receive
preoperative chemotherapy depends on a variety of factors,
according to Mieog, although cost is not an issue: "The costs
of chemotherapy are not significantly different before or
after surgery."

According to the Centers for Disease Control and Prevention,
breast cancer is the most common cancer in women, regardless
of race or ethnic background. The National Cancer Institute
estimates that 192,000 American women are diagnosed with
breast cancer each year.

###

Mieog JSD, van der Hage JA, van de Velde CJH. Preoperative
chemotherapy for women with operable breast cancer (Review).
Cochrane Database of Systematic Reviews 2007, Issue 2.

The Cochrane Collaboration is an international nonprofit,
independent organization that produces and disseminates
systematic reviews of health care interventions and promotes
the search for evidence in the form of clinical trials and
other studies of interventions. Visit http://www.cochrane.org
for more information."


--
Matti Narkia

Matti Narkia wrote:

>
> Preoperative chemotherapy for women with operable breast cancer.

This is off-topic here and if you care about this newsgroup you will quit posting about it
(here).
J - alt.support.cancer

On Thu, 10 May 2007 20:04:38 -0400, J <nexsw@nvalid,anon> wrote:

>Matti Narkia wrote:
>
>>
>> Preoperative chemotherapy for women with operable breast cancer.
>
>This is off-topic here and if you care about this newsgroup you will quit posting about it
>(here).

It is certainly _not_ off topic here. If it bothers you, don't read
it.


--
Matti Narkia

Matti Narkia wrote:

>
> J wrote:
> >This is off-topic here and if you care about this newsgroup you will quit posting about it
> >(here).
>
> It is certainly _not_ off topic here. If it bothers you, don't read
> it.

If you don't stop, you, Matti Narkia, will bring a lot of trouble to this newsgroup.
Your ignorance will be the downfall of this newsgroup. So stop it.
J

Matti Narkia wrote:

> J
> >This is off-topic here and if you care about this newsgroup you will quit posting about it
> >(here).

On Fri, 11 May 2007 05:26:25 -0400, J <nexsw@nvalid,anon> wrote:

>Matti Narkia wrote:
>
>>
>> J wrote:
>> >This is off-topic here and if you care about this newsgroup you will quit posting about it
>> >(here).
>>
>> It is certainly _not_ off topic here. If it bothers you, don't read
>> it.
>
>If you don't stop, you, Matti Narkia, will bring a lot of trouble to this newsgroup.
>Your ignorance will be the downfall of this newsgroup. So stop it.
>
Some people including me have asked this before and I ask again:
What's wrong with you? Perhaps it would be good for you and the group,
if you'd take a deep breath, calmed down, and tried to objectively
review the criticism some people have recently presented here about
your behavior. We need more open discussion here without having to
fear groundless accusations from you.

All the best,

Matti Narkia

Matti Narkia wrote:

> On Fri, 11 May 2007 05:26:25 -0400, J <nexsw@nvalid,anon> wrote:
>
> >Matti Narkia wrote:
> >
> >>
> >> J wrote:
> >> >This is off-topic here and if you care about this newsgroup you will quit posting about it
> >> >(here).
> >>
> >> It is certainly _not_ off topic here. If it bothers you, don't read
> >> it.
> >
> >If you don't stop, you, Matti Narkia, will bring a lot of trouble to this newsgroup.
> >Your ignorance will be the downfall of this newsgroup. So stop it.
> >
> Some people including me have asked this before and I ask again:
> What's wrong with you? Perhaps it would be good for you and the group,
> if you'd take a deep breath, calmed down, and tried to objectively
> review the criticism some people have recently presented here about
> your behavior. We need more open discussion here without having to
> fear groundless accusations from you.

It is not anything wrong with me.
It is other people on other newsgroups. You will draw them and many troubles, here.
Mike R and Steph know exactly what the problems are and we do not discuss them.
This topic is to be avoided on this newsgroup. End of story.
J

On Fri, 11 May 2007 06:29:35 -0400, J <nexsw@nvalid,anon> wrote:

>Matti Narkia wrote:
>
>> On Fri, 11 May 2007 05:26:25 -0400, J <nexsw@nvalid,anon> wrote:
>>
>> >Matti Narkia wrote:
>> >
>> >>
>> >> J wrote:
>> >> >This is off-topic here and if you care about this newsgroup you will quit posting about it
>> >> >(here).
>> >>
>> >> It is certainly _not_ off topic here. If it bothers you, don't read
>> >> it.
>> >
>> >If you don't stop, you, Matti Narkia, will bring a lot of trouble to this newsgroup.
>> >Your ignorance will be the downfall of this newsgroup. So stop it.
>> >
>> Some people including me have asked this before and I ask again:
>> What's wrong with you? Perhaps it would be good for you and the group,
>> if you'd take a deep breath, calmed down, and tried to objectively
>> review the criticism some people have recently presented here about
>> your behavior. We need more open discussion here without having to
>> fear groundless accusations from you.
>
>It is not anything wrong with me.

I'm not convinced :-(.

>It is other people on other newsgroups. You will draw them and many troubles, here.
>Mike R and Steph know exactly what the problems are and we do not discuss them.
>This topic is to be avoided on this newsgroup. End of story.
>J

I disagree and it is not the end of the story regardless of whatever
you say. We certainly do not need any kind of secrecy here, we need
open discussion.

All the best,

Matti Narkia

>
>> J
>> >This is off-topic here and if you care about this newsgroup you will
>> >quit posting about it
>> >(here).
>

It is my general experience that any item longer than about 5KB is pretty
useless. It's either a conversation that should have been snipped, that
ironjustice freek or somebody posting reams of technical jargon that should
just have a url pointing for those interested.
Either way I ignore anything that long as a matter of habit and would urge
others to do the same or the newsgroup gets clogged and unwieldy
MIKE

Mike Radcliffe wrote:

> >
> >> J to Matti
> >> >This is off-topic here and if you care about this newsgroup you will
> >> >quit posting about it
> >> >(here).
>
> It is my general experience that any item longer than about 5KB is pretty
> useless. It's either a conversation that should have been snipped, that
> ironjustice freek or somebody posting reams of technical jargon that should
> just have a url pointing for those interested.
> Either way I ignore anything that long as a matter of habit and would urge
> others to do the same or the newsgroup gets clogged and unwieldy

Absolutely and people are still not snipping.
Mine shows lines, not KB. I wasn't aware that OE shows the size. How many lines
is 5KB please?
I have to get moving soon and compare Free Agent to a different newsreader (for
plonking and other features) and decide which one I want to install and try (and
probably uninstall x-news - too teckkie for me).

So the people who want to be regulars better shape up or get plonked or posts
will be ignored.
J

On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
<mikeradcliffenospam@iinet.net.au> wrote:
>
>It is my general experience that any item longer than about 5KB is pretty
>useless. It's either a conversation that should have been snipped, that
>ironjustice freek or somebody posting reams of technical jargon that should
>just have a url pointing for those interested.

Interesting, although I have to say that I have different criteria to
access the quality the quality of usenet articles. The length of the
article is not one of them, although ademittedly too long is too long.
But I think that opinions about what is too long vary, and in some
cases the extra length may not be bad at all. I agree with the
snipping part though. Carrying a long pile of comments from previous
messages can make a message fairly difficult to read. Perhaps we
should pay more attention to this. As for excerpts from outside
articles, it's a bit more difficult to create general rule. Naturally
overlong citations can be tiring, and may even violate copyright, but
moderate length quotations give some idea about what can be expected
from behind the link and whether it's worth following it. If the
article is not long, it could sometimes be presented in its entirity,
if that doesn't violate copyright; the origin should of course be
mentioned and link provided, if it is web article. If one only gives a
link, although in some cases that may also be a good solution and even
necessary, it requires some extra effort from the reader, s/he has to
move from the newsreader to a new environment of the web browser.
Without knowing what to expect, the threshold may be too high in many
cases. With quotations the poster is likely to reach a larger
audience.

> Either way I ignore anything that long as a matter of habit and would urge
>others to do the same or the newsgroup gets clogged and unwieldy
>MIKE
>
I think that that kind of "urging" is an overkill here. Messages are
here generally fairly brief, and infrequent longer messages are no
burden at least not for me. You mileage may differ, but I would
greatly appreciate if you'd show some tolerance and wouldn't try force
everyone to follow your preferences and expectations.



--
Matti Narkia

On Tue, 15 May 2007 18:01:57 +0300, Matti Narkia <mna@mbnet.fi> wrote:

>On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
><mikeradcliffenospam@iinet.net.au> wrote:
>>
>>It is my general experience that any item longer than about 5KB is pretty
>>useless. It's either a conversation that should have been snipped, that
>>ironjustice freek or somebody posting reams of technical jargon that should
>>just have a url pointing for those interested.
>
>Interesting, although I have to say that I have different criteria to
>access the quality the quality of usenet articles. The length of the
>article is not one of them, although ademittedly too long is too long.
>But I think that opinions about what is too long vary, and in some
>cases the extra length may not be bad at all. I agree with the
>snipping part though. Carrying a long pile of comments from previous
>messages can make a message fairly difficult to read. Perhaps we
>should pay more attention to this. As for excerpts from outside
>articles, it's a bit more difficult to create general rule. Naturally
>overlong citations can be tiring, and may even violate copyright, but
>moderate length quotations give some idea about what can be expected
>from behind the link and whether it's worth following it. If the
>article is not long, it could sometimes be presented in its entirity,
>if that doesn't violate copyright; the origin should of course be
>mentioned and link provided, if it is web article. If one only gives a
>link, although in some cases that may also be a good solution and even
>necessary, it requires some extra effort from the reader, s/he has to
>move from the newsreader to a new environment of the web browser.
>Without knowing what to expect, the threshold may be too high in many
>cases. With quotations the poster is likely to reach a larger
>audience.
>
>> Either way I ignore anything that long as a matter of habit and would urge
>>others to do the same or the newsgroup gets clogged and unwieldy
>>MIKE
>>
>I think that that kind of "urging" is an overkill here. Messages are
>here generally fairly brief, and infrequent longer messages are no
>burden at least not for me. You mileage may differ, but I would
>greatly appreciate if you'd show some tolerance and wouldn't try force
>everyone to follow your preferences and expectations.

Mike, one more thing: Do you have/had cancer? If not, it would be
interesting know why you hang out here? No offence, I'm just curious.


--
Matti Narkia

Matti Narkia wrote:

> On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
>
> > Either way I ignore anything that long as a matter of habit and would urge
> >others to do the same or the newsgroup gets clogged and unwieldy
> >MIKE
> >
> I think that that kind of "urging" is an overkill here. Messages are
> here generally fairly brief, and infrequent longer messages are no
> burden at least not for me. You mileage may differ, but I would
> greatly appreciate if you'd show some tolerance and wouldn't try force
> everyone to follow your preferences and expectations.

Yuu just posted 132 lines to "newbie here" and did not give any clues as to why
she's getting cramps.
Nor suggestions, nor trouble-shooting tips.
J

Matti Narkia wrote:

> Mike, one more thing: Do you have/had cancer? If not, it would be
> interesting know why you hang out here? No offence, I'm just curious.

Mike's our resident hospice expert here.
And our Australian representative, in case there's healthcare related information
required by posters.
He's been of invaluable help here, for many years.
J

On Tue, 15 May 2007 14:54:28 -0400, J <nexsw@nvalid,anon> wrote:

>Matti Narkia wrote:
>
>> On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
>>
>> > Either way I ignore anything that long as a matter of habit and would urge
>> >others to do the same or the newsgroup gets clogged and unwieldy
>> >MIKE
>> >
>> I think that that kind of "urging" is an overkill here. Messages are
>> here generally fairly brief, and infrequent longer messages are no
>> burden at least not for me. You mileage may differ, but I would
>> greatly appreciate if you'd show some tolerance and wouldn't try force
>> everyone to follow your preferences and expectations.
>
>Yuu just posted 132 lines to "newbie here" and did not give any clues as to why
>she's getting cramps.
>Nor suggestions, nor trouble-shooting tips.
>J

So? It's common for cancer patients to share their experiences. We
feel that it's helpful, at least I do. But you don't seem to know
tjat, or if do, you don't seem to care. And I'm not a doctor, I'm not
trying to practice medicine without licence. That would be a crime,
wouldn't it?

I ask you the same question than from Mike: if you don't have cancer
and never had, why are you hanging out here? You certainly have caused
nothing but trouble for me, and you still try to do that. Perhaps some
others feel that they get some emotional support from you. If so,
that's perfectly ok with me. But please, please know your limitations
and try not to interpret medical studies or science in general, you
have no competence for that. And try to refrain from giving medical
advice, you are not qualified for that either, therefore it may not
even be legal. It's fine to share information or pointers to
information, though.


--
Matti Narkia

On Tue, 15 May 2007 14:56:47 -0400, J <nexsw@nvalid,anon> wrote:

>Matti Narkia wrote:
>
>> Mike, one more thing: Do you have/had cancer? If not, it would be
>> interesting know why you hang out here? No offence, I'm just curious.
>
>Mike's our resident hospice expert here.

Good to know, thanks for sharing that with us. As for discussions in
this group that experience may have its advantages and disadvantages.
Hospice candidates or patients could benefit, but hospice knowledge
may not be so useful for functional patients, who hope and expect to
be cured.

>And our Australian representative, in case there's healthcare related information
>required by posters.

We don't have or need any representatives here, just cancer patients,
their caretakers, and perhaps some other supporters.

>He's been of invaluable help here, for many years.
>
Perhaps for some patients needing hospice care. Personally, I haven't
found his messages useful, and in recent PEG-tube discussion his
"advice" was outright misleading and IMHO perhaps even harmful.
Perhaps his experience with hospice was a disadvantage in that case,
because most head and neck cancer patients here are functional and
unlike some hospice patients, they probably could greatly benefit from
PEG-tube during radiation. I know that I did.

When you mentioned "many years" I take an opportunity to mentioned
that according to google groups my first post in this group seems to
have been over 11 years ago, on the 27th of March 1996:

<http://groups.google.com/group/alt.support.cancer/msg/1b282d4ef2c3a932?dmode=source&hl=en>

I don't remember seeing Mike or you around here then.


--
Matti Narkia

> Absolutely and people are still not snipping.
> Mine shows lines, not KB. I wasn't aware that OE shows the size. How many
> lines
> is 5KB please?

Too many to count but as a rough guide 1kb=1page on my screen ie I have to
'page down' 5 times to read the whole item..way too much for me but I don't
speed read either
MIKE

>
>> Either way I ignore anything that long as a matter of habit and would
>> urge
>>others to do the same or the newsgroup gets clogged and unwieldy
>>MIKE
>>
> I think that that kind of "urging" is an overkill here. Messages are
> here generally fairly brief, and infrequent longer messages are no
> burden at least not for me. You mileage may differ, but I would
> greatly appreciate if you'd show some tolerance and wouldn't try force
> everyone to follow your preferences and expectations.-
> Matti Narkia

Just as an addition to this there is an alt.sci.med.cancer ng that would be
much more appropriate for discussions of a technical nature. It is not
unusual to get longer messages there and people specifically interested tend
to congregate there.
MIKE

On Wed, 16 May 2007 08:35:27 +0800, "Mike Radcliffe"
<mikeradcliffenospam@iinet.net.au> wrote:

>>
>>> Either way I ignore anything that long as a matter of habit and would
>>> urge
>>>others to do the same or the newsgroup gets clogged and unwieldy
>>>MIKE
>>>
>> I think that that kind of "urging" is an overkill here. Messages are
>> here generally fairly brief, and infrequent longer messages are no
>> burden at least not for me. You mileage may differ, but I would
>> greatly appreciate if you'd show some tolerance and wouldn't try force
>> everyone to follow your preferences and expectations.-
>> Matti Narkia
>
>Just as an addition to this there is an alt.sci.med.cancer ng that would be
>much more appropriate for discussions of a technical nature. It is not
>unusual to get longer messages there and people specifically interested tend
>to congregate there.
>
You probably mean the group sci.med.diseases.cancer. I'm aware of that
and I post the overwhelming majority of my technical messages only
there. However, a few somewhat technical studies or related messages
may have at least limited interest also from the cancer support
viewpoint, hence I occasionally post this kind of messages also here.
'J' seems to follow similar protocol in her posting. I don't see this
kind of practice causing any problems, on the contrary, IMHO some
people may actually benefit from it.


--
Matti Narkia

"Matti Narkia" <mna@mbnet.fi> wrote in message
news:2jjj43dpgrbl6r5relqvuhnpm2bjnp13ku@4ax.com...
> On Tue, 15 May 2007 18:01:57 +0300, Matti Narkia <mna@mbnet.fi> wrote:
>
>>On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
>><mikeradcliffenospam@iinet.net.au> wrote:
>>>
>>>It is my general experience that any item longer than about 5KB is pretty
>>>useless. It's either a conversation that should have been snipped, that
>>>ironjustice freek or somebody posting reams of technical jargon that
>>>should
>>>just have a url pointing for those interested.
>>
>>Interesting, although I have to say that I have different criteria to
>>access the quality the quality of usenet articles. The length of the
>>article is not one of them, although ademittedly too long is too long.
>>But I think that opinions about what is too long vary, and in some
>>cases the extra length may not be bad at all. I agree with the
>>snipping part though. Carrying a long pile of comments from previous
>>messages can make a message fairly difficult to read. Perhaps we
>>should pay more attention to this. As for excerpts from outside
>>articles, it's a bit more difficult to create general rule. Naturally
>>overlong citations can be tiring, and may even violate copyright, but
>>moderate length quotations give some idea about what can be expected
>>from behind the link and whether it's worth following it. If the
>>article is not long, it could sometimes be presented in its entirity,
>>if that doesn't violate copyright; the origin should of course be
>>mentioned and link provided, if it is web article. If one only gives a
>>link, although in some cases that may also be a good solution and even
>>necessary, it requires some extra effort from the reader, s/he has to
>>move from the newsreader to a new environment of the web browser.
>>Without knowing what to expect, the threshold may be too high in many
>>cases. With quotations the poster is likely to reach a larger
>>audience.
>>
>>> Either way I ignore anything that long as a matter of habit and would
>>> urge
>>>others to do the same or the newsgroup gets clogged and unwieldy
>>>MIKE
>>>
>>I think that that kind of "urging" is an overkill here. Messages are
>>here generally fairly brief, and infrequent longer messages are no
>>burden at least not for me. You mileage may differ, but I would
>>greatly appreciate if you'd show some tolerance and wouldn't try force
>>everyone to follow your preferences and expectations.
>
> Mike, one more thing: Do you have/had cancer? If not, it would be
> interesting know why you hang out here? No offence, I'm just curious.
>

He's a nurse with special expertise in palliative care. One of the most
valuable common-sense resources here.

On Wed, 16 May 2007 03:01:13 GMT, "Steph" <steph@vancouvers.island>
wrote:

>
>"Matti Narkia" <mna@mbnet.fi> wrote in message
>news:2jjj43dpgrbl6r5relqvuhnpm2bjnp13ku@4ax.com.. .
>> On Tue, 15 May 2007 18:01:57 +0300, Matti Narkia <mna@mbnet.fi> wrote:
>>
>>>On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
>>><mikeradcliffenospam@iinet.net.au> wrote:
>>>>
>>>>It is my general experience that any item longer than about 5KB is pretty
>>>>useless. It's either a conversation that should have been snipped, that
>>>>ironjustice freek or somebody posting reams of technical jargon that
>>>>should
>>>>just have a url pointing for those interested.
>>>
>>>Interesting, although I have to say that I have different criteria to
>>>access the quality the quality of usenet articles. The length of the
>>>article is not one of them, although ademittedly too long is too long.
>>>But I think that opinions about what is too long vary, and in some
>>>cases the extra length may not be bad at all. I agree with the
>>>snipping part though. Carrying a long pile of comments from previous
>>>messages can make a message fairly difficult to read. Perhaps we
>>>should pay more attention to this. As for excerpts from outside
>>>articles, it's a bit more difficult to create general rule. Naturally
>>>overlong citations can be tiring, and may even violate copyright, but
>>>moderate length quotations give some idea about what can be expected
>>>from behind the link and whether it's worth following it. If the
>>>article is not long, it could sometimes be presented in its entirity,
>>>if that doesn't violate copyright; the origin should of course be
>>>mentioned and link provided, if it is web article. If one only gives a
>>>link, although in some cases that may also be a good solution and even
>>>necessary, it requires some extra effort from the reader, s/he has to
>>>move from the newsreader to a new environment of the web browser.
>>>Without knowing what to expect, the threshold may be too high in many
>>>cases. With quotations the poster is likely to reach a larger
>>>audience.
>>>
>>>> Either way I ignore anything that long as a matter of habit and would
>>>> urge
>>>>others to do the same or the newsgroup gets clogged and unwieldy
>>>>MIKE
>>>>
>>>I think that that kind of "urging" is an overkill here. Messages are
>>>here generally fairly brief, and infrequent longer messages are no
>>>burden at least not for me. You mileage may differ, but I would
>>>greatly appreciate if you'd show some tolerance and wouldn't try force
>>>everyone to follow your preferences and expectations.
>>
>> Mike, one more thing: Do you have/had cancer? If not, it would be
>> interesting know why you hang out here? No offence, I'm just curious.
>>
>
>He's a nurse with special expertise in palliative care. One of the most
>valuable common-sense resources here.
>
Ok, Steph. But his "advice" on PEG-tubes some time ago may had been ok
for hospice patients approaching the end of their life, but it was
plain wrong and probably even harmful for functional head and neck
cancer patients waiting for radiation treatment.


--
Matti Narkia

Matti Narkia wrote:

> On Wed, 16 May 2007 03:01:13 GMT, "Steph" <steph@vancouvers.island>
> wrote:
>
> >
> >"Matti Narkia" <mna@mbnet.fi> wrote in message
>
> >> On Tue, 15 May 2007 18:01:57 +0300, Matti Narkia <mna@mbnet.fi> wrote:
> >>
> >>>On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
> >>><mikeradcliffenospam@iinet.net.au> wrote:
> >>>>
> >>>>It is my general experience that any item longer than about 5KB is pretty
> >>>>useless. It's either a conversation that should have been snipped, that
> >>>>ironjustice freek or somebody posting reams of technical jargon that
> >>>>should
> >>>>just have a url pointing for those interested.
> >>>
> >>>Interesting, although I have to say that I have different criteria to
> >>>access the quality the quality of usenet articles. The length of the
> >>>article is not one of them, although ademittedly too long is too long.
> <snip>
> >>>> Either way I ignore anything that long as a matter of habit and would
> >>>> urge
> >>>>others to do the same or the newsgroup gets clogged and unwieldy
> >>>>MIKE
> >>>>
> >>>I think that that kind of "urging" is an overkill here. Messages are
> >>>here generally fairly brief, and infrequent longer messages are no
> >>>burden at least not for me. You mileage may differ, but I would
> >>>greatly appreciate if you'd show some tolerance and wouldn't try force
> >>>everyone to follow your preferences and expectations.
> >>
> >> Mike, one more thing: Do you have/had cancer? If not, it would be
> >> interesting know why you hang out here? No offence, I'm just curious.
> >>
> >
> >He's a nurse with special expertise in palliative care. One of the most
> >valuable common-sense resources here.
> >
> Ok, Steph. But his "advice" on PEG-tubes some time ago may had been ok
> for hospice patients approaching the end of their life, but it was
> plain wrong and probably even harmful for functional head and neck
> cancer patients waiting for radiation treatment.

This is what he wrote. "Your Diet" March/2007
"For some a feeding tube is the right thing, for some it may not be.
Before deciding on this intervention patients would be well advised to be
sure exactly what they are to expect from the treatment they are having and
where their disease is likely to go. Ask the doctor and nurses for realistic
information and not just the best case scenarios.
This advice applies to all those considering feeding tubes both with cancer
and non-cancer diagnoses. "
I see nothing wrong with that.

I can't find anything that "Mike Radcliffe" (nor under his current posting email
address) wrote about "Peg" since 2003.
If you have an issue, that I have not found, it's up to you to cite it here.(or
address it at the time, which is probably what happened).
J

Mike Radcliffe wrote:

> >
> >> Either way I ignore anything that long as a matter of habit and would
> >> urge
> >>others to do the same or the newsgroup gets clogged and unwieldy
> >>MIKE
> >>
> > I think that that kind of "urging" is an overkill here. Messages are
> > here generally fairly brief, and infrequent longer messages are no
> > burden at least not for me. You mileage may differ, but I would
> > greatly appreciate if you'd show some tolerance and wouldn't try force
> > everyone to follow your preferences and expectations.-
> > Matti Narkia
>
> Just as an addition to this there is an alt.sci.med.cancer ng that would be
> much more appropriate for discussions of a technical nature. It is not
> unusual to get longer messages there and people specifically interested tend
> to congregate there.
> MIKE

sci.med.diseases.cancer and yes, there's a number of topics that would well be
better on sci.med.diseases.cancer including the original topic of this one.
Including prevention and medicines, which includes aspirin.

J

On Wed, 16 May 2007 03:41:29 -0400, J <nexsw@nvalid,anon> wrote:

>Matti Narkia wrote:
>
>> On Wed, 16 May 2007 03:01:13 GMT, "Steph" <steph@vancouvers.island>
>> wrote:
>>
>> >
>> >"Matti Narkia" <mna@mbnet.fi> wrote in message
>>
>> >> On Tue, 15 May 2007 18:01:57 +0300, Matti Narkia <mna@mbnet.fi> wrote:
>> >>
>> >>>On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
>> >>><mikeradcliffenospam@iinet.net.au> wrote:
>> >>>>
>> >>>>It is my general experience that any item longer than about 5KB is pretty
>> >>>>useless. It's either a conversation that should have been snipped, that
>> >>>>ironjustice freek or somebody posting reams of technical jargon that
>> >>>>should
>> >>>>just have a url pointing for those interested.
>> >>>
>> >>>Interesting, although I have to say that I have different criteria to
>> >>>access the quality the quality of usenet articles. The length of the
>> >>>article is not one of them, although ademittedly too long is too long.
>> <snip>
>> >>>> Either way I ignore anything that long as a matter of habit and would
>> >>>> urge
>> >>>>others to do the same or the newsgroup gets clogged and unwieldy
>> >>>>MIKE
>> >>>>
>> >>>I think that that kind of "urging" is an overkill here. Messages are
>> >>>here generally fairly brief, and infrequent longer messages are no
>> >>>burden at least not for me. You mileage may differ, but I would
>> >>>greatly appreciate if you'd show some tolerance and wouldn't try force
>> >>>everyone to follow your preferences and expectations.
>> >>
>> >> Mike, one more thing: Do you have/had cancer? If not, it would be
>> >> interesting know why you hang out here? No offence, I'm just curious.
>> >>
>> >
>> >He's a nurse with special expertise in palliative care. One of the most
>> >valuable common-sense resources here.
>> >
>> Ok, Steph. But his "advice" on PEG-tubes some time ago may had been ok
>> for hospice patients approaching the end of their life, but it was
>> plain wrong and probably even harmful for functional head and neck
>> cancer patients waiting for radiation treatment.
>
>This is what he wrote. "Your Diet" March/2007
>"For some a feeding tube is the right thing, for some it may not be.
>Before deciding on this intervention patients would be well advised to be
>sure exactly what they are to expect from the treatment they are having and
>where their disease is likely to go. Ask the doctor and nurses for realistic
>information and not just the best case scenarios.
>This advice applies to all those considering feeding tubes both with cancer
>and non-cancer diagnoses. "
>I see nothing wrong with that.
>
>I can't find anything that "Mike Radcliffe" (nor under his current posting email
>address) wrote about "Peg" since 2003.
>If you have an issue, that I have not found, it's up to you to cite it here.(or
>address it at the time, which is probably what happened).
>
You are displaying your ignorance. The name of the most common type
feeding tube currently used for example by head and neck cancer
patients during radiation therapy is PEG-tube and that's what we
discussed regardless of whether some debaters specificly used that
name or not. But it doesn't really matter what type of feeding tube it
was, the question was whether head and neck cancers waiting for
radiation need a (whatever type) feeding tube inserted or not. They
do, unless they are completely disoriented or demented and there is
possibility that they would try to pull out the tube, but we don't
have that kind of patients here. There is absolutely no need to send
confusing signals about feeding tubes to head and neck cancer patients
in this group.


--
Matti Narkia

On Wed, 16 May 2007 04:15:01 -0400, J <nexsw@nvalid,anon> wrote:

>Mike Radcliffe wrote:
>
>> >
>> >> Either way I ignore anything that long as a matter of habit and would
>> >> urge
>> >>others to do the same or the newsgroup gets clogged and unwieldy
>> >>MIKE
>> >>
>> > I think that that kind of "urging" is an overkill here. Messages are
>> > here generally fairly brief, and infrequent longer messages are no
>> > burden at least not for me. You mileage may differ, but I would
>> > greatly appreciate if you'd show some tolerance and wouldn't try force
>> > everyone to follow your preferences and expectations.-
>> > Matti Narkia
>>
>> Just as an addition to this there is an alt.sci.med.cancer ng that would be
>> much more appropriate for discussions of a technical nature. It is not
>> unusual to get longer messages there and people specifically interested tend
>> to congregate there.
>> MIKE
>
>sci.med.diseases.cancer and yes, there's a number of topics that would well be
>better on sci.med.diseases.cancer including the original topic of this one.

That's where I strongly disgree with you. IMHO the original topic of
this one very much concerns also support group.

>Including prevention and medicines, which includes aspirin.
>
Not IMHO. And I don't think we need much more of this meta-discussion.
It doesn't benefit the patients and it could be harmful for this
group. Only people who possibly enjoy it are people with bureaucrat or
web cop mentality, or people who like to bully others.




--
Matti Narkia

Matti Narkia wrote:

> On Wed, 16 May 2007 04:15:01 -0400, J <nexsw@nvalid,anon> wrote:
>
> >sci.med.diseases.cancer and yes, there's a number of topics that would well be
> >better on sci.med.diseases.cancer including the original topic of this one.
>
> That's where I strongly disgree with you. IMHO the original topic of
> this one very much concerns also support group.
>
> >Including prevention and medicines, which includes aspirin.
> >
> Not IMHO. And I don't think we need much more of this meta-discussion.
> It doesn't benefit the patients and it could be harmful for this
> group. Only people who possibly enjoy it are people with bureaucrat or
> web cop mentality, or people who like to bully others.

Apparently you've been gone for over 7 years.
You've missed a lot.
This newsgroup has been cleaned up a lot (and safer for newbies, than before) and I
intend for it to stay so, whether you like or not.
Breast cancer is off topic here.
J

Matti Narkia wrote:

> On Wed, 16 May 2007 03:41:29 -0400, J <nexsw@nvalid,anon> wrote:
>
> >Matti Narkia wrote:
> >
> >> On Wed, 16 May 2007 03:01:13 GMT, "Steph" <steph@vancouvers.island>
> >> wrote:
> >>
> >> >
> >> >"Matti Narkia" <mna@mbnet.fi> wrote in message
> >>
> >> >> On Tue, 15 May 2007 18:01:57 +0300, Matti Narkia <mna@mbnet.fi> wrote:
> >> >>
> >> >>>On Mon, 14 May 2007 18:46:42 +0800, "Mike Radcliffe"
> >> >>><mikeradcliffenospam@iinet.net.au> wrote:
> >> >>>>
> >> >>>>It is my general experience that any item longer than about 5KB is pretty
> >> >>>>useless. It's either a conversation that should have been snipped, that
> >> >>>>ironjustice freek or somebody posting reams of technical jargon that
> >> >>>>should
> >> >>>>just have a url pointing for those interested.
> >> >>>
> >> >>>Interesting, although I have to say that I have different criteria to
> >> >>>access the quality the quality of usenet articles. The length of the
> >> >>>article is not one of them, although ademittedly too long is too long.
> >> <snip>
> >> >>>> Either way I ignore anything that long as a matter of habit and would
> >> >>>> urge
> >> >>>>others to do the same or the newsgroup gets clogged and unwieldy
> >> >>>>MIKE
> >> >>>>
> >> >>>I think that that kind of "urging" is an overkill here. Messages are
> >> >>>here generally fairly brief, and infrequent longer messages are no
> >> >>>burden at least not for me. You mileage may differ, but I would
> >> >>>greatly appreciate if you'd show some tolerance and wouldn't try force
> >> >>>everyone to follow your preferences and expectations.
> >> >>
> >> >> Mike, one more thing: Do you have/had cancer? If not, it would be
> >> >> interesting know why you hang out here? No offence, I'm just curious.
> >> >>
> >> >
> >> >He's a nurse with special expertise in palliative care. One of the most
> >> >valuable common-sense resources here.
> >> >
> >> Ok, Steph. But his "advice" on PEG-tubes some time ago may had been ok
> >> for hospice patients approaching the end of their life, but it was
> >> plain wrong and probably even harmful for functional head and neck
> >> cancer patients waiting for radiation treatment.

Cite ?
(search the archives youself and tinyurl his post)
J

On Wed, 16 May 2007 05:05:51 -0400, J <nexsw@nvalid,anon> wrote:

>Matti Narkia wrote:
>
>> On Wed, 16 May 2007 04:15:01 -0400, J <nexsw@nvalid,anon> wrote:
>>
>> >sci.med.diseases.cancer and yes, there's a number of topics that would well be
>> >better on sci.med.diseases.cancer including the original topic of this one.
>>
>> That's where I strongly disgree with you. IMHO the original topic of
>> this one very much concerns also support group.
>>
>> >Including prevention and medicines, which includes aspirin.
>> >
>> Not IMHO. And I don't think we need much more of this meta-discussion.
>> It doesn't benefit the patients and it could be harmful for this
>> group. Only people who possibly enjoy it are people with bureaucrat or
>> web cop mentality, or people who like to bully others.
>
>Apparently you've been gone for over 7 years.

That's not true. According to google group search I've posted in this
group in every year from 1996 to 2007 except in 2005, although in many
years fairly infrequently.

>You've missed a lot.

I've certainly not missed your posts, because your unacceptable
behavior was the main reason I started to post here less frequently.
Other reason was that I was fairly busy in sci.med.nutrition,
sci.life-extension, sci.med.cardiology and in a Finnish health related
usenet group sfnet.keskustelu.terveys. In some years I participated
also in CANCER-L mailing list. And unlike now, I was working full
time.

>This newsgroup has been cleaned up a lot (and safer for newbies, than before) and I
>intend for it to stay so, whether you like or not.

I've never known to make any newsgroup I post "unsafe" :-). People
seem to like having me around :-). Ask for example sci.med.nutrition,
sci.life-extension, alt.support.cancer.prostate or browse or search
them with google group. Or sfnet.keskustelu.terveys if you know
Finnish ;-).

I wish you'd stop acting like you owned this group or were its
moderator, that could and have put some people off. A news flash: you
don't (own this group) and you are not (its moderator).

I don't know what are you doing here anyway - apparently you have
never had cancer and you don't have any medical qualifacitions. So
once more: why are you hanging out here?

>Breast cancer is off topic here.

Bullshit, that's not up to you decide. IMHO its completely on topic.
If you have annoyed someone with breast cancer that's your problem and
you should deal with it. If that's the case it's perhaps not wise for
_you_ to post about breast cancer.


--
Matti Narkia