Principles of cancer treatment

Oxford American handbook of oncology. Second Edition. Oxford University Press (2015)

The Modern management of patients with malignant disease generally involves several clinical disciplines

  • Initial management includes establishing the diagnosis based on a definitive biopsy followed by appropriate staging procedures often including but not limited to various radiographic, radionuclide, magnetic resonance, or other imaging techniques.
  • Management of patients with solid tumors generally involves primary surgical intervention frequently followed by systemic therapies and/or radiation therapy.
  • The sequential orchestration of surgery, radiation therapy, chemotherapy, and hormonal therapy as well as newer target agents such as monoclonal antibodies and small molecule inhibitors have made the treatment of many malignancies very complex but increasingly effective at altering the course of disease, including the potential for survival or even cure.
  • In addition, the rapid increase in knowledge from basic, clinical, and translational cancer research has led to an information explosion in the field of cancer that is beyond anyone’s capability to stay abreast of.

Therefore, no single clinician has all the knowledge and all the skills necessary to effectively treat most cancers or even a single cancer in an optimal manner in today’s world

  • This has led to the development of multidisciplinary teams that deal with one or a limited class of specific types of cancer in a comprehensive manner.
  • In addition to the assembly of pathologists, radiologists, and other imaging specialists, surgeons, radiation therapists, medical oncologists, and hematologists, such teams often include a broad array of essential allied healthcare specialists including but not limited to nurses, social workers, and pharmacists.
  • Even as patients approach a point in their disease in which standard interventions are no longer reasonable or desired, a coordinated team of individuals is required to offer appropriate palliative or end-of-life care with optimal symptom control such as pain management, treatment of depression, etc.
  • Thus, the makeup of the team may change over time to include individuals who are not directly involved in the initial treatment at presentation but have adjunctive roles at later stages in the course of the illness.

There should always be a sufficient range of expertise to allow for informed discussion of the best management policy for individual patients.

The team’s various roles will include the following:

  • Planning diagnostic and staging procedures
  • Managing the primary treatment approach including any adjuvant therapy to be delivered pre- or postoperatively
  • Preparing patients physically and psychologically for cancer treatment and subsequent follow-up
  • Providing information on treatment, prognosis, side effects, and other pertinent questions that might arise
  • Efficiently planning and delivering surgery, radiotherapy, and systemic therapy as appropriate
  • Effectively managing treatment-associated toxicities with appropriate supportive care
  • Aiding rehabilitation from the disease and its treatment
  • Providing appropriate follow-up care
  • Ensuring that the transition from curative to palliative care is appropriately and compassionately managed
  • Facilitate the availability and possible recruitment to appropriate clinical trials

Patient management within such a multidisciplinary team structure results in better outcomes for patients.

Studies demonstrate survival advantages, and, equally important, patients experience less compromise of functional and psychological well being and better quality of life.


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