24 * 7 Medical Helpline for Cancer Patients AsmiConsultancyHerbals@gmail.com

Outcomes of Cancer Treatments

Let your life lightly dance on the edge of Time, like dew on the tip of a leaf.

Diagnosis, prognosis and treatment are central to the management of cancer patients. There are many factors that influence the cancer prognosis or outcome. Foremost among these is the stage of the disease at the time of diagnosis. The stage indicates the size of the tumour, and how far it has spread to other parts of the body. Other factors that determine prognosis are: the organ where the cancer is located; the grade of the tumour indicative of how closely it resembles the tissue of origin under the microscope; cancer traits as assessed by the pathologist; age of the patient; health of the individual at the time of diagnosis; and the response to treatment.

Based on a combination of these factors, a favourable prognosis is given when it appears that the patient is likely to respond well to the treatment. Conversely, an unfavourable prognosis indicates that the individual is unlikely to show any benefits from treatment. Moreover, prognosis is a prediction based on data and is not set in stone for any given patient. Some tumours have a better prognosis than others. Conventionally, good prognosis has been described for testicular and skin cancers, while it is poor in oesophageal and pancreatic cancers. At times, the presence of certain markers (like Capn-4) on the cell surface of some cancers heralds a poor prognosis.

Disease-free survival is a statistic-it indicates the percentage of patients who can be expected to have no sign of the original cancer after a fixed period of time, following a standard recommended treatment protocol. Depending on and site of cancer, this measure may be one, two, three, or five years. This data is based on large groups of patients, and therefore cannot always accurately predict the response of an individual case.

The five-year disease-free survival rate is generally used as a standard way of discussing prognosis, as well as a way to compare the value of one treatment over another. It is an estimate and is expressed as a percentage, based on information gathered on hundreds and thousands of patients with a specific type of cancer. When a five-year survival is expressed as 80 per cent for a given tumour, then it means that eighty out of every hundred patients treated are still alive five years after the diagnosis.

What does the cancer survival rate fail to tell us and how does it impact us? Even though it gives a general idea of what the outcome is likely to be, it is never specific to the individual. It also does not suggest that a patient can expect to live for only five years after stoppage of treatment, or that the cancer has been cured for all time.

If asked, the treating oncologist generally reveals to the patient what his/her prognosis is likely to be, depending on this statistic. Seeking information about prognosis is a personal choice, and patients should decide how much information they require themselves. Being fully informed about the likely course of their disease helps practical planning and making treatment decisions. The likelihood of a good prognosis may encourage the patient to undertake more aggressive options, if available, with a goal of achieving remission. On the other hand, patients with a poor prognosis may instead opt for palliative care.

The concept of cure implies that there is no trace of cancer after the treatment has been completed. It is assessed after a specific time frame using multiple parameters, with help from clinical, radiological and/or pathological means. Within remission, on the other hand, 'complete remission' indicates the disappearance of signs and symptoms, while they are greatly reduced in partial remission'. Remission that persists for five years or more may be considered a cure by some oncologists. The persistence of even a few malignant cells in the body, even in a suppressed state, may be the source of recurrence in case of poor nutrition or low immunity.

Another measure of success in cancer treatment is quality of life. Poor health-related quality of life may be due to the symptoms of the cancer, the side-effects of treatment, and, indirectly, due to psychological problems associated with the diagnosis of a potentially fatal condition. Other chronic illnesses may add to the burden even after the cancer is in remission or has been cured.

In India we often use Western statistics to predict the outcome for cancer, not taking into account the many other variables that exist in the Indian scenario. There is an enormous difference in the prognosis among the rural and urban cancer victims. With little or no medical facilities in remote rural areas, patients tend to seek medical help in the late stages of the disease.

In the advanced stages, the treatment objective is to slow down or stop the advancement of the cancer and, thus, to prolong life-even though the cancer cannot be cured. At times, only active surveillance and follow up may be necessary for the rest of the patient's life. Active surveillance is based on the concept that in low-risk cancer like some cancers of the prostate, the patients do not warrant aggressive, immediate treatment; they are given treatment only when necessary. These patients may live a normal life without therapy for a number of years and may die of causes other than the cancer.