In contrast to previous decades, the 1990s have witnessed an increase of new agents with significant activity in breast cancer, including chemotherapy, hormone therapy, and, more recently, biologic modifiers. All information appears to confirm that such a trend will persist and even accelerate in the coming decades. Unless clear strategies of development for new drugs are strictly followed, it will become difficult to adequately assess the many new agents with potentially important activity against breast cancer, and patient access may become a limiting key factor. The academic, global virtual concept is calling for the definition of a new relationship between the pharmaceutical industry and clinical researchers. The main aspect is related to the creation of partnerships with an academically controlled global strategy of development for promising new agents, in which the quality and independence of processes (adjuvant setting, for example) are critical. The means are based on the globalization of patient access (worldwide network) and the virtuality of the approach (modern means of communication as well as access to subgroups of patients). The Breast Cancer International Research Group is the first academic global virtual cooperative group in breast cancer and is making contributions in the development of new drugs, such as taxanes, new antiestrogens, and new cytokines.
This survey was designed to investigate the current status of the management of cancer pain in Finland. In 1995 a questionnaire was randomly sent to 5% (n = 546) of Finnish physicians, excluding specialists not expected to treat cancer patients. Two previous surveys, using the same questionnaire, were conducted in 1985 and 1990 by Vainio. The response rate was 53%. Seventy-nine percent of the respondents treated one or less than one cancer patient a week. Sixty-seven percent of them assessed the severity of cancer pain in their patients as being at least moderate. In 10 years, the proportion of physicians suggesting the WHO analgesic ladder principle to their 'typical cancer patient' had increased from 12% to 28%. At the same time, the suggestions of 'analgesic' without definition had decreased from 48% to 6%. Three simulated patient cases were presented. The mean daily dose of opioids suggested for severe terminal cancer pain corresponded to 72 (18-300) mg of intramuscular morphine in 1995, being only 39 (1-77) mg in 1985 for the same simulated patient case. Continuous infusion of opioid was recommended by 59% of the respondents. Non-steroidal anti-inflammatory drugs as the treatment of choice for bone metastases pain in a patient with breast cancer, was recommended by 68% of the respondents. In the case of local severe pain due to recurrent rectal cancer, 63% of the physicians suggested anaesthetic intervention. Insufficient pain relief and lack of experience were the most common difficulties in pain management. Only one-third of the physicians thought that they had enough time and ability to give sufficient psychological support to their patients.