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To the Editor: In their analysis of the patterns of care for adults with newly diagnosed malignant glioma enrolled in the Glioma Outcomes Project,¹ Dr Chang and colleagues concluded that practice patterns may at times conflict with current literature (eg, infrequent use of chemotherapy) or contradict accepted guidelines (88% of patients received prescription of antiepileptic drugs, with only 32% reporting seizures). In an editorial in the same issue, Drs Fisher and Buffler² question whether the current state of treatment for these patients approaches "therapeutic nihilism." The unmet medical needs of these patients are clearly illustrated by the finding that 28.5% of the patients used some form of alternative medicine. This is hardly surprising, since no significant difference in survival was found between those participants enrolled in formal clinical trials and those participating in alternative therapies.

With such a consistently poor prognosis for malignant gliomas, what is most striking is the . . . [Full Text of this Article]

Robert P. Shannon, MD
shannon.robert@mayo.edu
Department of Family Medicine
Mayo Clinic
Jacksonville, Fla

Jerry W. Sayre, MD
Department of Family Medicine
Mayo Graduate School of Medicine
Jacksonville, Fla

Judith J. Sayre, PhD
Department of Health Communications
University of North Florida
Jacksonville

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