Cancer
Cancer: Care During and After Treatment
What human trials show about side effects of cancer treatment, life after treatment, supplements tested to prevent cancer, and screening. This page is about care alongside standard treatment. It covers nothing offered in place of it.
Records whose trials enrolled people with cancer, or that were tested to prevent it. Every record here was tested alongside standard cancer treatment, after it, or in people without cancer; none was tested in place of treatment.
During treatment
Side effects of radiotherapy and chemotherapy, and products tested as add-ons to treatment.
- ABlinded clinician ratingDevice or therapy · Randomized controlled trials People are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect. + meta-analysis A study that pools the numbers from several trials into one combined estimate. of randomized trialsEndpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score.: Severe (grade 3 to 4) oral mucositis during head and neck radiotherapy or chemoradiation and stem cell transplant, graded by blinded clinicians
- CHard clinical endpointSupplement · Randomized trials and meta-analyses in Japanese surgical patients, mixedEndpoint: Overall survival after curative resection of colorectal or gastric cancer, PSK added to chemotherapy
- CSurrogate biomarkerSupplement · Cochrane reviews of small randomized trials; one placebo-controlled trialGrade for: Immune cell measures as an adjunct A treatment tested on top of standard prescribed therapy rather than in place of it. to cancer treatment
- CMeasured functionSupplement · Meta-analyses + RCT Randomized controlled trial: people are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect.Endpoint: Cognition in mild cognitive impairment and mild Alzheimer's disease, and diabetic neuropathy painTested to prevent nerve damage from taxane chemotherapy in 409 women with breast cancer: at 3,000 mg a day for 24 weeks it made the nerve damage worse than placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received. at 24 weeks, and the difference persisted to two years. The letter above is for a different use. Hershman, J Clin Oncol 2013; Hershman, J Natl Cancer Inst 2018 · 23733756 29361042
After treatment
Survivorship: recurrence, survival after curative treatment, and lymphedema.
- BHard clinical endpointProtocol · Meta-analysis of randomized trialsEndpoint: Disease-free survival and overall survival after curative-intent treatment for non-metastatic cancer, structured exercise program against health education or usual care
- BMeasured functionDevice or therapy · Systematic review A review that searches for every study on a question using a method set in advance, then assesses them together. of randomized trialsEndpoint: Limb volume reduction (clinical lymphedema)
- BMeasured functionProtocol · Meta-analysis of randomized trials (VTE, hard endpoint An outcome that matters directly to a person and is counted without judgment, such as death, heart attack, stroke or fracture.)Grade for: Clinical lymphedema, limb volume reduction
- DSurrogate biomarker · Not yet testedSupplement · Single-arm Phase II studies for the prostate use; two null placebo-controlled trials in other usesGrade for: PSA kinetics in non-metastatic biochemically relapsed prostate cancer
Tested to prevent cancer
Supplements given to people without cancer in large trials to lower cancer rates. None lowered them. Beta-carotene and vitamin E raised them, and folic acid raised precancerous polyps.
- DHard clinical endpoint · Tested, no benefitSupplement · RCTs + meta-analyses (use-specific)Grade for: Cancer prevention (already-replete adults)
- DHard clinical endpoint · Tested, no benefitSupplement · Pooled reviews of randomized trials and large randomized trialsGrade for: Cancer prevention
- DHard clinical endpoint · Tested, harm foundSupplement · Randomized controlled trials (harm found → D Route 2 Human randomized trials have been run and did not show benefit on the stated outcome. One of the two routes to the lowest letter on EBL's scale.)Endpoint: Tested at scale for cancer prevention in six large trials. Beta-carotene alone raised lung cancer in male smokers (ATBC); beta-carotene with retinyl palmitate raised lung cancer and death in smokers and asbestos workers (CARET, stopped early); in mostly non-smoking physicians and women it did nothing. A harm finding in smokers, a null in everyone else.
- DHard clinical endpoint · Tested, harm foundSupplement · Large randomized trials and pooled reviews, no benefit, harm signal in one trialEndpoint: Tested at scale for cancer prevention with no benefit in any large trial. In SELECT, 400 IU/day of synthetic vitamin E significantly increased prostate cancer in healthy men on extended follow-up; a second large trial in healthy men at 400 IU every other day found no prostate effect either way.
- DHard clinical endpoint · Tested, no benefitSupplement · Randomized controlled trials + pooled analysis (no benefit, D Route 2)Endpoint: Tested for colorectal adenoma recurrence in three placebo-controlled trials and a pooled analysis of 2,632 patients. No reduction. The largest trial raised the possibility of more advanced neoplasia, and its long-term follow-up found more sessile serrated lesions with extended use; no overall cancer increase was found across 13 trials.
Screening
Graded on whether screening lowered cancer deaths.
- AHard clinical endpointDevice or therapy · Randomized trials of the screening strategy, by testEndpoint: Colorectal cancer mortality (hard endpoint), graded separately by test
- DSurrogate biomarker · Tested, no benefitDevice or therapy · Tested in one large randomized trial; primary endpoint The one outcome a trial names in advance as its main test. Results on other outcomes carry less weight. not metEndpoint: Incidence of late-stage (III and IV) cancer at diagnosis, a stage-shift surrogate for cancer mortality
- DHard clinical endpoint · Not yet testedDevice or therapy · No randomized outcome trial; pooled observational Research that watches what people already do rather than assigning a treatment. It can show that two things travel together, not that one causes the other. yield data onlyEndpoint: Cancer mortality or all-cause mortality in asymptomatic screened adults
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