They seek to answer treatment questions using a randomized and placebo controlled design that pairs a new treatment plan with the standard of care for that disease. Although not uniformly true, clinical trials often do not place the burden of payment on the patient or their insurance. Despite subsidized financing, many insurance plans, particularly managed care and health maintenance organizations have been reluctant to allow their covered patients to be placed on experimental therapy . Clinical trials are available at large centers of excellence, but increasingly can be found at smaller community centers and should be encouraged if the patient is amenable. Antineoplastic agents exert their toxicity not only on cancerous tissue, but likewise take their toll on otherwise normal, healthy tissues.
Most toxicity is seen in cell types that are rapidly dividing.
Thus, common sites of toxicity include the blood, hair and skin, especially the mucosal tissues. The suppression of blood cells is commonly seen with antineoplastic treatments. Neutropenia, or lowering of the white blood cell population, represents a serious threat to patients in that it is a temporary compromise in the immune system. Many chemotherapy regimes take their toll on the red blood cells with a decline as witnessed by a drop in both hemoglobin and hematocrit measures. The sloughing or turnover of mucosal tissues presents a serious problem for patients.