Cancer treatmentsCancer treatments are being continually developed. Increasingly more effective and better-targeted treatments are available. As treatment has developed, the outcomes have improved. Treatment outcomes in Finland are outstanding by international comparisons. The purpose of cancer treatments is that cancer improves the disease is brought under control cancer recurrence is prevented, and the symptoms caused by the tumour are alleviated. The main forms of cancer treatment are cancer surgery (surgical treatment), radiotherapy, chemotherapy and hormone therapy. Nowadays various immunological therapies and so-called smart drug delivery (or targeted drug delivery) are also used. There are a variety of different cancer drugs available. They are usually used in combination. Cancer therapy is personalised, which is why treatments can vary. The choice of treatment is influenced by the location of the tumour, distribution, cell type and the patient’s overall condition as well as possible other illnesses. The advantages and disadvantages for the patient of different treatments are always assessed beforehand. A doctor decides on the kind of treatment, but as a patient you can ask questions and express your own wishes on the matter. The doctor must explain to you the grounds for and content of the treatment recommendation. Patients’ rights Some cancers progress so slowly that the situation can be monitored for a while before the type of treatment is selected and started. Surgery is often sufficient for the treatment of small malignant tumours. Sometimes it’s possible to use only chemotherapy or drug therapy instead. The treatment of large tumours involves various combinations of surgery, radiotherapy and drug therapy. Surgery can be supplemented with other cancer therapies to treat patients. Everyone with cancer wants to receive treatment as soon as possible. Waiting for treatment can heighten anxiety. However, it is not usually possible to start treatment immediately once diagnosis is confirmed as further tests have to be carried out. Defining the cancer type precisely is important in selecting the right treatment method. The staging classification of the cancer has also to be ascertained as treatment of a cancer that has spread or is in situ can differ greatly. Many cancers develop slowly over several years. The delay of a few weeks in starting cancer treatment is usually insignificant in terms of the treatment’s final outcome. With some cases of acute leukaemia or malignant brain tumours, though, even a fairly short delay in treatment can be important. Cancer therapy is a mental and physical strain on patients. Its side effects commonly include nausea, hair loss, reduced blood count, fatigue and swelling of the lower limbs. The efficacy of cancer therapy (response to treatment) and the adverse effects caused by the treatments are closely monitored. Rehabilitation Cancer treatment in practice Patients receive cancer therapy in hospital. As tests progress, the patient is transferred from care at a health centre to specialised care. Cancer treatment is always personalised. Treatment is usually carried out under the supervision of an oncologist at an oncology clinic or ward. Treatment plans involve specialists from different medical fields. Rare and particularly difficult cases of cancer are treated at certain university hospitals. Children with cancer are usually treated at the children’s clinics of university hospitals. Post-treatment monitoring is carried out on an individual basis. At first, patients are usually under specialist observation and then later at a health centre. In cases of incurable cancer, at some point patients are transferred for specialised treatment at health centres. Individual plans for symptomatic treatment are drawn up for patients. In addition to receiving health centre care, patients may receive palliative, or supportive, care at health care units at the oncology clinics. Palliative care is provided at individual hospices, health centre palliative care units or hospitals. Different types of cancer treatment Combination therapy Cancer treatment often involves combination therapy. Combination therapy refers to the combined use of many treatment forms, such as surgery, radiotherapy and drugs. The purpose of combination therapy is to increase the patient’s scope for recovery. Adjuvant therapy Adjuvant therapy is used to supplement surgery. Radiotherapy or chemotherapy provided following surgery are forms of adjuvant therapy. Adjuvant therapy ensures that cancer cells are destroyed, thereby improving the patient’s prognosis. Supportive therapy Supportive cancer therapy alleviates symptoms caused by cancer or its treatment. It can improve the patient’s wellbeing during and after the period of treatment. For instance, the anti-nausea medication used during chemotherapy is a form of supportive therapy. Cancer pain treatment is another form of supportive therapy. Palliative care Palliative care alleviates the patient’s physical and psychological symptoms to improve the quality of life. Palliative care is used in cancer treatment or to treat the symptoms arising from cancer treatment. Palliative care can be provided for months or even years. The most common symptoms treated in palliative care are pain, constipation, nausea, confusion and fatigue. Palliative care is provided in tandem with curative treatment immediately following cancer diagnosis. If cancers cannot be cured, treatment focuses on the patients’ symptoms so that their quality of life can be as good as possible. For patients with metastatic cancer, palliative care is of central importance. The procedures used in symptomatic therapy may in part be the same as those used in curative treatment. For instance, radiotherapy can reduce metastases, which helps patients feel better. Treatment also seeks to alleviate patients’ psychological symptoms, in addition to physical ones, such as the fears and anxieties that come toward the end of life. Terminal care Approaching death Treatment fatigue Up to 50 – 90 per cent of cancer patients suffer from treatment fatigue during their illness and periods of treatment. This involves extreme tiredness and fatigue that does not pass simply with sleeping and resting. Further information on treatment fatigue Treatment studies and drug trials Research is used to develop cancer treatments. Clinical trials or treatment studies are research studies done with patients. Laboratory testing and animal testing precede clinical trials. The advantages and disadvantages of a new form of treatment are studied for a long time before patient trials are started. There are many sorts of clinical trials. They are used, among other things, to: seek methods by which cancer can be prevented, develop early detection, develop treatment, investigate the psychological impacts of cancer, or explore the scope for improving patients’ quality of life. Many clinical trials study new forms of cancer therapy: surgical procedures, radiotherapy and drug therapy, or a combination of these. With a clinical trial, the personal responsible adhere to a research protocol that carefully specifies what is to be done, when and why. Before the start of the trial, the Ethics Committee examines the protocol and independent individuals assess the ethics of the trial. The aims of the research and the practical matters related to being patients in a clinical trial as well as the possible advantages and disadvantages of the new form of treatment are explained to patients before they take part in the trial. If patients do not want to participate in a trial, they will receive treatment as normal according to current treatment recommendations. If they wish, patients taking part in trials can stop doing so and transfer to normal treatment. Sources Joensuu, Heikki; Jyrkkiö, Sirkku; Kellokumpu-Lehtinen, Pirkko-Liisa; Kouri, Mauri; Roberts, Peter J. & Teppo, Lyly (toim.) (2013) Syöpätaudit. Helsinki: Kustannus Oy Duodecim. Suomen Syöpäpotilaat ry. Selviytyjän matkaopas. Helsinki, 2014.