From Mathematical Models to Palliative Care and Psycho- Oncology
Pp. 157-180 (24)
Pierre R. Band
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.
Goldie-Coldman model, intermittent androgen suppression, Norton-
Simon model, total pain, palliative care, psycho-oncology.
Faculty of Medicine, McGill University, Montreal, Quebec H3G 1Y6, Canada.