Asunto(s)
Formularios de Consentimiento/legislación & jurisprudencia , Servicio de Radiología en Hospital/legislación & jurisprudencia , Radioterapia , Australia , Humanos , Registros Médicos/legislación & jurisprudencia , Servicio de Oncología en Hospital/legislación & jurisprudencia , Cooperación del Paciente , Oncología por Radiación/legislación & jurisprudenciaRESUMEN
Medical malpractice litigation is increasing. Delay in diagnosis is the commonest basis for litigation involving the treatment of breast cancer. When delay in diagnosis has occurred, any losses for which a plaintiff seeks compensation require estimates to be made of any change in prognosis over the period of the delay relative to the extent of disease found when treatment is finally undertaken. We have examined the natural history of breast cancer and have attempted to provide evidence-based quantitative guidelines for the evaluation of the losses which may be claimed in malpractice cases.
RESUMEN
The physical symptoms and side-effects reported by patients treated for early breast cancer with surgery (S), (breast conservation or mastectomy), radiotherapy (R) and chemotherapy (C) are reported. As part of a large quality-of-life study, eligible patients were invited to complete a questionnaire at three and 12 months after treatment for early breast cancer. Symptoms 2 weeks after surgery were retrospectively collected at the 3-month questionnaire. Comparing the commonly used different therapy combinations (S, S+R, S+C and S+R+C) we found the only loco-regional symptom to show a significant difference between these groups was chest tightness (P<0.001). Both anxiety about attending for and discomfort during C were significantly higher than during R (P<0.00005 and 0.00001 respectively). We found that the addition of R and, or, C to S resulted in surprisingly little variation in physical side-effects.
RESUMEN
The present study investigated outcomes for 78 women with epithelial ovarian carcinoma treated by whole abdominal radiotherapy (WART) after cyto-reductive surgery at Westmead Hospital between 1980 and 1993. These patients had 5-year relapse-free and overall survival rates of 52 and 55%, respectively. The median follow-up was 7.5 years. Fifty-eight of the 78 women fulfilled the criteria as defined by the Princess Margaret Hospital's intermediate risk' category. These patients had both a relapse-free and overall survival rate of 62% at 5 years (P = 0.001 as compared with the remaining 20 women). Mild gastrointestinal upset was common during radiotherapy. Five women did not complete treatment. Late toxicity (grade 3 or more, using the Radiotherapy Oncology Group (RTOG) system) occurred in eight women, and five women required surgery for intestinal complications (6.4%). There were no deaths due to late side effects. In conclusion the results are consistent with those of other series in the treatment of epithelial ovarian cancer by adjuvant WART. When compared to a similar-stage disease treated with cisplatin-based chemotherapy, there is no evidence to support the exclusive use of chemotherapy.
Asunto(s)
Carcinoma Endometrioide/diagnóstico por imagen , Neoplasias Ováricas/radioterapia , Adulto , Anciano , Carcinoma/diagnóstico por imagen , Carcinoma/mortalidad , Carcinoma/cirugía , Carcinoma Endometrioide/mortalidad , Carcinoma Endometrioide/cirugía , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/mortalidad , Neoplasias Ováricas/terapia , Radiografía Abdominal , Radioterapia/efectos adversosRESUMEN
BACKGROUND: Breast conservation has been shown to be a safe and effective alternative to mastectomy in early-stage breast cancer. The present study reviews the long-term outcome and toxicity after treatment of early breast cancer by conservative surgery and radiation. METHODS: Between November 1979 and December 1989, 438 patients with Union Internationale Contre le Cancer (UICC) stage I or II breast cancer were treated with conservative surgery and radiation therapy (CS+RT) at Westmead Hospital. Surgery to the breast varied from a local excision to a quadrantectomy, depending on the preference of the referring surgeon. The axilla was surgically dissected in 299 patients (68%). All patients received postoperative breast irradiation. The whole breast was irradiated to 46-54 Gy (median dose, 50 Gy) using 6 Mev photons for 5-6.5 weeks. Boosts were given at the primary tumour site in 336 patients (78%), by electron therapy (88 patients), iridium-192 (247 patients) or photons (one patient). A total of 44 patients (10%) received adjuvant chemotherapy. RESULTS: The median follow-up period for surviving patients was 84 months (range: 56-172 months). The 5-year actuarial rate of local recurrence was 6% (312 patients at risk), and the 10-year rate was 10% (52 patients at risk). Very young patients (aged 34 years at diagnosis) had a 5-year actuarial rate of local recurrence of 13% compared to 5% for older patients (P = 0.04). Neither the total dose to the primary site nor the boost technique influenced local recurrence. The 5-year freedom from distant relapse was 83%. The side effects included rib fractures (2%), symptomatic pneumonitis (3%), fatty necrosis or fibrosis requiring surgery (4%), and moderate-severe oedema of the arm (7%). CONCLUSIONS: The long-term data show that CS+RT for UICC stage I or II breast cancer results in low rates of local recurrence which are influenced by age at diagnosis, but not by radiation dose or boost technique. These results confirm those of other international series that CS+RT is a safe alternative to mastectomy for most women with operable breast cancer.
Asunto(s)
Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Mastectomía Segmentaria , Recurrencia Local de Neoplasia/etiología , Análisis Actuarial , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Mastectomía Segmentaria/efectos adversos , Mastectomía Segmentaria/métodos , Persona de Mediana Edad , Nueva Gales del Sur , Radioterapia Adyuvante/efectos adversos , Resultado del TratamientoRESUMEN
The measurement of linear accelerator workload in radiation oncology departments is usually based on the number of fields treated per unit time. However, this approach ignores variations in treatment complexity. This prospective study, was designed to measure treatment workload directly, taking into account the variations in complexity of different treatment techniques. From this, a model was to be developed, which would be simple to apply and reproducible, both within and between radiation oncology departments in Australasia. It would provide a realistic basis for assessing treatment costs and enable the comparison of patient throughput between departments. This paper describes the derivation of the model. Over a 4-week period in the Radiation Oncology Department of Westmead Hospital, all fractions of radiotherapy were timed. The data collected included: tumour site; treatment intent; number of fields; number of wedges, compensators and shielding blocks; fraction number; patient age; performance status; and need for general anaesthesia. Multivariate modelling was performed to identify factors that significantly affected fraction duration, so that these could be used to develop a model of resource utilization. The durations of 2371 fractions were measured in 219 patients. Seventy-five per cent of fractions were given with radical intent. The factors found to influence fraction duration on multivariate modelling were: number of fields; number of shielding blocks; first treatment fraction; need for anaesthesia; and performance status. The number of wedges and compensators were also found to be significant but were not included in the model in order to maintain simplicity. This was felt to be necessary if the model is to be applied to the widest possible variety of machines. A model of resources utilization called 'Basic Treatment Equivalent' (BTE) was derived, which incorporated these factors. When tested at Westmead Hospital, this model accurately reflected the predicted BTE value over a further 1-week study period. This model of linear accelerator use, which incorporates complexity has been derived and evaluated in one radiation oncology department. This requires further prospective testing before its widespread use. The model appears to reflect linear accelerator workload better than previous measures. An Australasian study to validate the model further will be undertaken. If adopted, this model has implications for comparative workload reports, diagnostic-related groups, waiting list calculations, and patient scheduling.
Asunto(s)
Aceleradores de Partículas/estadística & datos numéricos , Carga de Trabajo , Eficiencia , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Radioterapia/estadística & datos numéricosRESUMEN
Current methods of linear accelerator workload analysis in radiation oncology use patients per hour or fields per hour as the basic unit of measurement but fail to take account of the variations in complexity of different treatment techniques. The Basic Treatment Equivalent (BTE) model of productivity assessment has been derived as a potentially better measure of workload because it includes a complexity factor. This model has now been tested prospectively in ten radiation oncology departments in New South Wales and compared with the numbers of fields and patients per hour. Over a 4-week period there were 50,115 fields administrated in 18,466 fractions in 441 hours of machine time in ten radiation oncology departments. The average productivity results for all departments were 4.18 patients, 11.25 fields and 5.66 BTE per hour. When compared with patients per hour and fields per hour, there was less variability of BTE per patient per hour in all departments, suggesting that most departments deliver radiation therapy in a consistent way, which is not appropriately reflected in the numbers of fields or patients per hour. Departments that were able to treat a high number of patients or fields per hour were able to do so because they used less complicated techniques or had a less complicated casemix of patients. The BTE model allows for variations in the complexity of treatment techniques, is simple to apply, and is reproducible under different conditions in different departments. Following revision of the model, an Australasian study is now proposed. The confirmation of our findings will have significant implications for resource utilization comparisons, patient time allocations, waiting list estimates and cost-benefit analysis.
Asunto(s)
Aceleradores de Partículas/estadística & datos numéricos , Carga de Trabajo , Eficiencia , Departamentos de Hospitales/estadística & datos numéricos , Humanos , Modelos Teóricos , Oncología por Radiación/estadística & datos numéricos , Radioterapia/estadística & datos numéricosRESUMEN
We reviewed 177 patients treated with radical radiotherapy for locally advanced (FIGO stages IIB, IIIA, IIIB) cervix cancer between January 1979 and December 1989. The radiotherapy was given by external beam treatment to the pelvis and by an intracavitary caesium insertion. Ninety-three patients also received chemotherapy which consisted of infusional 5-fluorouracil during the first and last weeks of the external beam component of the radiotherapy, combined with bolus mitomycin C (group A, 64 patients) or without mitomycin C (group B, 29 patients). These groups were compared with patients treated by radiotherapy alone (group C, 84 patients). The median follow-up was 7.2 years. The median survival time for all patients was 47 months, but was significantly higher (87 months, p = 0.004) for group A. Rates of relapse-free survival and local control were also higher in group A. Toxicity was assessed in detail using the Franco-Italian glossary. There was a relatively high rate of complications, particularly in group A, with 36% of patients having grade 3 or 4 complications. This increase in toxicity persisted through all follow-up time intervals. Patients in group B also demonstrated a higher rate of toxicity than group C, but this increase was limited to the first 6 months of follow-up. The use of mitomycin C in addition to radiotherapy and 5-fluorouracil should be regarded with caution, as other studies have also shown that toxicity is increased, but without improvements in survival.
Asunto(s)
Adenocarcinoma/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Braquiterapia , Carcinoma Adenoescamoso/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias del Cuello Uterino/radioterapia , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Adenoescamoso/tratamiento farmacológico , Carcinoma Adenoescamoso/mortalidad , Carcinoma Adenoescamoso/patología , Carcinoma de Células Escamosas/tratamiento farmacológico , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Terapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Mitomicina/administración & dosificación , Estadificación de Neoplasias , Tasa de Supervivencia , Resultado del Tratamiento , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/patologíaRESUMEN
Over the years three different concepts regarding the cure of treated breast cancer have emerged. These are clinical cure, personal cure and statistical cure. The latter is the most accurate estimate of the curability of a disease which is presumed to be fatal unless treated. Statistical cure is the elimination of the hazard of death in a treated group compared with an age-matched control population. When statistical cure is studied in patients treated for early breast cancer, it is clear that breast cancer is an incurable disease. The expected gains from the relatively recent introduction of adjuvant therapy are too small to alter this concept. The significance of prognostic factors in a disease deemed to be incurable therefore requires re-examination. The conventional prognostic factors of tumour size, nodal status and a combination of those two in staging systems significantly discriminates in terms of survival in the short term. However, when the characteristics of long-term survivors are examined, neither tumour size nor nodal status discriminates effectively. If this is the case, then we need to reconsider novel treatment strategies which have been introduced in the hope of increasing the curability of the disease and the selection for those treatment strategies of patients using the conventional prognostic factors of tumour size or nodal involvement.
Asunto(s)
Neoplasias de la Mama/mortalidad , Distribución por Edad , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/cirugía , Terapia Combinada , Femenino , Humanos , Mastectomía , Pronóstico , Tasa de SupervivenciaAsunto(s)
Neoplasias de la Mama/etiología , Enfermedad de Hodgkin/radioterapia , Neoplasias Inducidas por Radiación/etiología , Neoplasias Primarias Secundarias/etiología , Adulto , Factores de Edad , Neoplasias de la Mama/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Mamografía , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/prevención & control , Neoplasias Primarias Secundarias/prevención & control , Radioterapia/efectos adversos , Factores de RiesgoRESUMEN
PURPOSE: This retrospective review examines local control, freedom from distant failure, and survival for patients with nonmetastatic breast cancer with extensive nodal disease (> 10 nodes, 45 patients; or > or = 70% involved nodes, if < 10 nodes found, 19 patients). All patients received chemotherapy and radiotherapy following mastectomy. PATIENTS AND METHODS: Sixty-four patients were treated between January 1980 and December 1988 at Westmead Hospital, Westmead, NSW Australia. The median follow-up duration for surviving patients was 91.5 months (range, 56 to 121). The median age was 51 years, and the median number of positive nodes was 11. Four successive protocols evolved, each with three phases, as follows: induction chemotherapy (doxorubicin or mitoxantrone, plus cyclophosphamide; three cycles), radiotherapy (50 Gy in 25 fractions to chest wall and regional nodes), then chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF]) of progressively shorter duration. Radiotherapy and chemotherapy were concurrent in the fourth regimen. RESULTS: One patient (1.5%) developed local recurrence before distant relapse, and seven patients (11%) developed local and/or regional recurrence simultaneously or after distant relapse. The 5-year actuarial freedom from distant relapse and overall survival rates were 45% and 65%, respectively. Overall survival did not vary significantly by menopausal status, nodal subgroup, or dose-intensity. There were no treatment-related deaths. CONCLUSION: Combined chemotherapy and radiotherapy in standard dosage is an acceptable approach following mastectomy for patients with extensive nodal involvement at high risk for local recurrence and distant relapse. This approach should be considered standard best therapy for any randomized trials that examine high-dose chemotherapy or bone marrow transplantation for this subgroup of patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/terapia , Metástasis Linfática , Adulto , Factores de Edad , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Neoplasias de la Mama/mortalidad , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Terapia Combinada , Ciclofosfamida/administración & dosificación , Ciclofosfamida/uso terapéutico , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático , Mastectomía , Metotrexato/administración & dosificación , Metotrexato/uso terapéutico , Persona de Mediana Edad , Mitoxantrona/administración & dosificación , Mitoxantrona/uso terapéutico , Recurrencia Local de Neoplasia , Cuidados Posoperatorios , Dosificación Radioterapéutica , Recurrencia , Estudios Retrospectivos , Factores de TiempoRESUMEN
PURPOSE: To evaluate the results of a departmental treatment policy in a consecutive series of patients with nonsmall cell carcinoma of the lung. A second purpose was to estimate the survival of patients treated with radical intent. A third purpose was to estimate the impact of comorbidity on the selection of patients for treatment and on its outcome. METHODS AND MATERIALS: The records of 720 consecutive patients referred to a single Department of Radiation Oncology between 1979 and 1985 were reviewed. One hundred fifty patients with early stage (Stage I and II disease) were studied in detail and the results are presented for the outcome of 103 patients treated by radical radiotherapy. All patients were followed for a minimum period of five years or until death. RESULTS: Patients referred for radiation therapy were elderly and usually had squamous cell carcinoma of the lung. Comorbidity was significant as was weight loss which occurred in a third of patients. The overall survival of patients treated with radical intent was 13%. In a small subgroup of patients with T1 tumors without weight loss and aged under 70 survival reached 50% at 5 years with no treatment-related mortality and with insignificant treatment-related morbidity. CONCLUSION: Highly selected subsets of patients suitable for treatment with radiotherapy can be defined equally as well as highly selected subsets of patients can be selected for surgery. Treatment outcome can be surprisingly good in these subsets indicating that the treatment of nonsmall cell lung cancer, particularly in older patients without comorbidity should not automatically be by a surgical approach.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Enfermedades Cardiovasculares/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Morbilidad , Estadificación de Neoplasias , Radioterapia/efectos adversos , Radioterapia/mortalidad , Análisis de Regresión , Enfermedades Respiratorias/epidemiología , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Pérdida de PesoRESUMEN
PURPOSE: First to describe clinical and pathologic features of sarcomas arising after radiation therapy for breast cancer and to report three cases of sarcoma arising 7, 15, and 20 years following radiation therapy for breast cancer. Second, to review the literature on this treatment complication. METHODS AND MATERIALS: Medline literature search. RESULTS: The most frequent histology is osteosarcoma and bone is affected more commonly than soft tissue at a median latency of 11 years. The scapula is the most frequently affected bone. The most frequently affected soft tissue site is now the conserved breast with a median latency of 5.5 years. The aetiologic factors relating to these sarcomas are not fully defined with factors of beam energy, radiation dose, chemotherapy and regional edema being inconsistently reported. CONCLUSION: The frequency of radiation-induced sarcoma at 10 years of follow-up is approximately 0.2%. This is an overestimate by an unknown factor because of the description of sarcomas arising metachromously in breast cancer patients, in nonirradiated areas.
Asunto(s)
Neoplasias de la Mama/radioterapia , Neoplasias Inducidas por Radiación/etiología , Radioterapia/efectos adversos , Sarcoma/etiología , Adulto , Neoplasias Óseas/etiología , Neoplasias Óseas/patología , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Hemangiosarcoma/etiología , Hemangiosarcoma/patología , Humanos , Persona de Mediana Edad , Neoplasias Inducidas por Radiación/patología , Osteosarcoma/etiología , Osteosarcoma/patología , Sarcoma/patologíaRESUMEN
The aim of this study was to examine the long term cost effectiveness of radiotherapy (RT) in the treatment of cancer at the Department of Radiation Oncology, Westmead Hospital, from its inception in 1980 to December 1993. A Kaplan-Meier survival curve was constructed for all patients treated by RT during the study period. The area under this curve represented the average survival. The total number of life years was calculated by multiplying the number of patients by the average survival. Costing for one RT treatment field had previously been derived. The cost included capital costs, building costs and overheads as well as labour, goods and services, and operating costs. The cost per field was multiplied by the total number of fields given each year and the yearly total summed to give the total cost. The total cost was divided by the number of life years to give a cost per life year. An overall percentage survival gain was estimated from departmental results and the literature. Cost per life year gained (LYG) was derived by dividing the cost per life year by the percentage survival gain. Sensitivity analysis was performed with best- and worst-case survival scenarios, and high and low cost per field estimates. A total of 9868 patients were treated by radiotherapy between January 1980 and December 1993. Median follow-up was 4.2 years. Median survival was 2 years. The 5- and 10-year survival rates were 35% and 22%, respectively. The area under the survival curve (the average survival) was 4.75 years. The total number of life years of survival was thus 4.75 x 9868 = 46,873. In 1993, the cost per field was $71.52 (Australian dollars). The total number of fields treated in the study period was 758,097. Hence, the total cost in 1993 dollars was $54,219,097. The survival gain (excluding skin cancer) with RT was 16.1% and the cost/LYG was $7186. Sensitivity analysis of best and worst case scenarios gave costs/LYG of $3920 and $15,632 respectively. Efficient resource allocation can be aided by examining the relative cost-effectiveness of different prevention and treatment strategies. RT is shown to have a lower cost/LYG than other accepted treatments in current practice. Other major treatment modalities should be subjected to the same scrutiny of cost effectiveness as has been applied to RT.
Asunto(s)
Radioterapia/economía , Australia , Análisis Costo-Beneficio , Humanos , Neoplasias/economía , Neoplasias/mortalidad , Calidad de Vida , Sensibilidad y Especificidad , Análisis de Supervivencia , Valor de la VidaRESUMEN
The clinical features and long-term outcome of seven patients with delayed cerebral radiation necrosis (DCRN) are described. Radiotherapy had been given for pituitary tumour (1), astrocytoma (2), pinealoma (2), craniopharyngioma (1) and parotid carcinoma (1). The mean latency to onset of the first neurological symptoms was 22 months (range 6-40 months), and mean duration of follow-up was 86 months (range 60-126). Three patients died at a mean of 84 months after radiotherapy (range 62-98). A fourth patient probably died from metastatic disease. Three patients remain alive, albeit severely disabled, after 5-10 years. The illness typically ran a stepwise course, with fits and stroke-like episodes occurring against a background of progressive dementia and somnolence. CT and MRI scans showed progressive ventricular dilatation associated with cerebral atrophy and diffuse or focal changes in the white matter. Four patients had had two or more neurosurgical procedures after the radiotherapy. In only one of the seven patients was the diagnosis made at presentation. DCRN produces a distinctive clinical picture, yet remains a poorly recognized complication of cranial irradiation.
Asunto(s)
Encéfalo/efectos de la radiación , Irradiación Craneana/efectos adversos , Traumatismos por Radiación/patología , Adolescente , Adulto , Astrocitoma/radioterapia , Neoplasias Encefálicas/radioterapia , Craneofaringioma/radioterapia , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Necrosis , Neoplasias de la Parótida/radioterapia , Glándula Pineal/patología , Pinealoma/radioterapia , Hipófisis/patología , Neoplasias Hipofisarias/radioterapia , Tomografía Computarizada de Emisión , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Between January 1954 and March 1964, 3926 patients with primary breast cancer were referred to The Department of Clinical Oncology, Edinburgh. One hundred and eighty patients developed 195 malignancies subsequent to the treatment of their initial breast cancer. Overall, the total number of second tumours was not significantly in excess of the expected incidence in the general population. However, statistical analysis revealed a significant increase in the incidence of rectal, skin and bone tumours. The excess of bone tumours was likely due to radiation exposure. There was not an overall excess of tumours within the irradiated or scattered radiation volume.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/radioterapia , Neoplasias Primarias Secundarias/epidemiología , Neoplasias de la Mama/cirugía , Estudios de Cohortes , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Mastectomía , Persona de Mediana Edad , Dosificación Radioterapéutica , Factores de Riesgo , Escocia/epidemiología , Factores de TiempoRESUMEN
Undergraduate cancer education in Australian medical schools is not integrated and there is little evidence of change in content or structure in recent years in spite of major changes in knowledge about cancer epidemiology and cancer biology, and in cancer management. A recent survey of graduating students/interns from all Australian medical schools revealed a disturbing variability in experience and lack of important knowledge. There was evidence of substantial differences in knowledge of, and rating of teaching between the different disciplines involved in cancer control and cancer management. To examine possible reasons for this, we surveyed cancer clinicians and teachers of oncology in the undergraduate curriculum at Australian medical schools. We asked them the same questions of knowledge as the students, and also to comment on the type and emphasis of teaching desirable in the medical students' cancer curriculum. The results indicate not only that the survey instrument was seen to be relevant, but also that some of the bias and misinformation detected in the student experiences may be attributed to attitude, knowledge and differences of opinion of the teachers. The results highlight the need for an integrated cancer curriculum to inform graduates about an illness which will be diagnosed in more than a quarter of the Australian population.