Cancer Management

Objectives

After completing this module, students should be able to:
  1. Understand two possible goals of cancer treatment.
  2. Describe the importance of patient, tumour, and treatment factors in cancer management.

There are two possible goals for treatment: cure and palliation. Curative treatment is considered to engender a small degree of risk of significant side effects for the possibility of cure. On the other hand, palliative care is considered to alleviate symptoms when the risks of significant side effects outweigh the benefit of possible cure.

Curative treatment is indicated when a curative technique (usually surgery) is available, patient factors are favourable (eg. lack of comorbid illnesses), and the disease progression is localized. If a patient does not have metastases, corresponding to a lower stage tumour, curative treatment is usually possible.

Palliative care is usually the goal when there is metastatic disease, and patient factors are unfavourable (eg. presence of comorbid illnesses).

In order to make decisions about curative or palliative treatment, tumour, treatment and patient factors are considered. Tumour factors relate to tumour stage and tumour type. Treatment factors include the type of treatment being considered, availability of treatment and efficacy of treatment. Patient factors include personal choice and age, and most importantly, the patient’s status. For example, a “young 65 year old” may be a better surgical candidate than a “tired-appearing 55 year old”. When thinking about treatment for a patient, their physical condition or ability to withstand and recover from any given treatment, is of paramount importance. In order to assess a patient’s performance status and effectively communicate this in a consistent way with colleagues, physicians use a performance grade developed by the Eastern Cooperative Oncology Group, called the ECOG performance status. The ECOG performance status is graded by asking the patient a series of questions during the history-taking process. The various grades are described below.

Table: ECOG Performance Status1
Grade ECOG
0 Fully active, able to carry on all pre-disease performance without restriction
1 Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work
2 Ambulatory and capable of all selfcare but unable to carry out any work activities. Up and about more than 50% of waking hours
3 Capable of only limited selfcare, confined to bed or chair more than 50% of waking hours
4 Completely disabled. Cannot carry on any selfcare. Totally confined to bed or chair
5 Dead

Health care providers who may be involved in the care of cancer patients include:

  • Family doctors
  • Radiologists
  • Respirologists and respiratory technicians
  • Surgeons or surgical oncologists
  • Radiation oncologists
  • Medical oncologists
  • Oncology nurses
  • Community care nurses
  • Oncology pharmacists
  • Physiotherapists
  • Occupational therapists
  • Registered dietitians
Summary:

Cancer treatment can be curative, if the disease has a chance of being completely eradicated by treatment. Palliative care is used to alleviate symptoms when the disease is not curative. Patient, tumour, and treatment factors guide the management of cancer patients which is provided by a multi-disciplinary team of health care professionals.


Major Contributors:

Leo Lai – Medical Student
Dr. Paris Ann Ingledew – MD, FRCP Radiation Oncologist

References:

1 Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and responce criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982 Dec;5(6):649-55.

Last Updated: August 2014