From Mathematical Models to Palliative Care and Psycho- Oncology

Several innovations of the 1960s and 1970s influenced the future development of medical oncology. The Goldie-Coldman mathematical model related drug sensitivity to chemotherapy to the spontaneous mutation rate of malignant cells towards drug resistance. It added a new dimension to the scientific evidence for primary systemic therapy of cancer (neoadjuvant), an approach first investigated in osteogenic sarcoma and breast cancer that brought a novel orientation to the treatment of solid tumors. The Norton-Simon mathematical model drew attention to the Gompertzian kinetics of solid tumor growth and to the inference that chemotherapy needed to be intensified after achieving a complete response. The finding that dihydrotestosterone is the active form of testosterone in the prostate and the discovery of the nuclear androgen receptor led investigators to study the basis of progression of prostate cancer to androgen independence; from this research emerged the concept of intermittent androgen suppression for the treatment of prostate cancer. The concept of “total pain”, with its physical, emotional, social and spiritual aspects, and the emergence of palliative care and psycho-oncology, opened an entirely new era of cancer care.

Keywords: Goldie-Coldman model, intermittent androgen suppression, Norton- Simon model, total pain, palliative care, psycho-oncology.