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Standard approach would likely be to choose a population of patients, randomize them between "chemo" and "chemo+immune" treatment groups, and then test for a si
by _ihaque 10y ago
Standard approach would likely be to choose a population of patients, randomize them between "chemo" and "chemo+immune" treatment groups, and then test for a significant difference in the metric of choice such as response rate or progression-free survival. The graphical analysis of these data is often done using Kaplan-Meier curves (https://en.wikipedia.org/wiki/Kaplan%E2%80%93Meier_estimator https://en.wikipedia.org/wiki/Kaplan%E2%80%93Meier_estimator)
- woliveirajr 10y agoSo, can't simple take some (or all) other children who are going through "just chemo" in any other hospital, or even in the same hospital? I think there are plenty of children in the world that are doing (suffering?) chemo everyday.
- aetherson 10y agoYou need a larger sample size than 2 to differentiate between the odds of "success due to just chemo" vs "success due to chemo + x treatment."
- emiliobumachar 10y agoNo, they can't. To do so would introduce confounding variables in the inevitably unique way they treat their subjects, even if it's just knowing you're part of the experiments. For maximum assurance of conclusions, such studies need to be double-blind: neither the subjects nor the researches who interact with them are to know who's taking just chemo and who's taking the new treatment.
- mikeash 10y agoYou'd want to eliminate as many potential confounding variables as possible. If they took the control group from another hospital, maybe that other hospital does something that improves or hurts their chances. Even if you pull from the same hospital, just being in the study might change the treatment they get in subtle ways. There's also the issue of blinding. If the control group is some outside group, then you know that everyone in the study group is receiving the new treatment. It would be much better if everyone involved didn't know whether any given patient was getting the new treatment or not until after all the results were in. For that, you need to recruit patients into the study, then randomly assign them to the new treatment or the conventional sort.
- true_religion 10y agoWith something like cancer which has a wide geographical coverage, and more or less standardised treatments, couldn't you get a good result from including everyone in hospital X in a treatment and comparing to the general public?
- voxic11 10y agoNo, cancer does not have standardized treatments. The remission rates vary greatly depending on the hospital and even on the doctor.
- sjg007 10y agoHuh...? There are standard treatment protocols.
- mhluongo 10y agoThe point still stands in practice- it's an interesting sociology of science topic. There are often unwritten rules and protocols that have a huge impact.
- gregshap 10y agoSpeaking from very recent experience, some things are obviously standard, like "take these pills twice a day" but cancer often comes with lots of ancillary issues, and most treatments come with side effects. There was a lot of variance in how doctors and nurses treated the side effects, how they spoke to the patient, what other resources they provided, the quality of bedside manner, their attentiveness to lab results and patient health over time, whether they consistently washed their hands, etc. People don't really die "of cancer" they die of things like blood loss, toxic build up from renal failure, blood clots, or infections acquired in the hospital that attack a weakened immune system, to name a few.
- sjg007 10y agoSure. Anyone with cancer should go to a high volume academic and designated cancer center. The hospital should also rate high in us news and reports and score top marks in nurses, safety and cleanliness. But you can't deviate from FDA guidelines except in very exceptional cases.