[Palliative chemotherapy]

Recent data on cancer mortality call for a reallocation of resources from searching for new treatments of advanced disease to preventive strategies. Vaccination against HBV or other infectious agents predisposing to cancer has been more successful than non-specific prevention e.g. with supplementary vitamin intake. The effectiveness of systemic chemotherapy decreases with the number of tumour cells present and with inherent drug resistance thus limiting palliative chemotherapy. stringent criteria for duration or intensity of palliative treatment are often missing. In contrast oncologic emergencies require immediate diagnostic work-up and therapeutic intervention. Salvage chemotherapy is useful if lack of host tolerance, non-compliance, and insufficient dose intensity have been excluded as causes of previous treatment failure in addition to analgesics, antibiotics, transfusions, and haematopoetic growth factors psychological support is needed along with palliative chemotherapy. The loss of treatment efficacy with increasing number of tumour cells probably also holds true for new treatments now still in their infancy such as differentiation, immune attack or gene transfer. Despite the obvious need for a shift from palliative treatment to prevention the establishment of quality standards for palliative chemotherapy remains a major goal.