How do you pray for the healing of cancer

Heal, delay, prevent - about treatment goals

Recognizing what is attainable, discussing what is desired, aligning therapy accordingly. Adjuvant? Neoadjuvant? Curative? Palliative? Supportive? Oncologists use these terms to describe the direction of treatment. If you or someone close to you is affected by a malignant disease, sooner or later you will be confronted with many of the terms mentioned, so these lines may help you find your way around. It's about

  • Adjuvant (= adjuvant intended) therapy
  • Neoadjuvant Therapy
  • Consolidation Therapy
  • Curative therapy
  • Palliative / palliative intended tumor therapy
  • Palliative medicine / "palliative care" / palliative medical care
  • BSC "best supportive care"
  • Supportive therapy - another overlapping of terms

One thing should never be forgotten: It will always be about finding the most correct approach to suit the individual situation. One that suits the person concerned, but also for the tumor disease in its threat. To do this, the oncologist will have to get to know the patient with their views, goals and conditions, but also need information about the type and spread of the malignant disease.

Adjuvant (= adjuvant intended) therapy

The term “adjuvant” is used particularly when one wants to make it clear that although a type of treatment with a very high level of effectiveness (usually the operation) has already been carried out successfully, further steps - referred to as adjuvant - now improve the result or make it safer should. These are usually complementary hormone therapy, chemotherapy, radiation therapy, or combinations. The adjuvant therapy therefore has a preventive character ("" for safety ""), without there being any guarantee of success.

Adjuvant chemotherapy is often used for breast cancer (breast cancer), colon cancer (colon cancer) and rectal cancer (rectal cancer), and in certain cases also for bronchial cancer (lung cancer).

Adjuvant therapies are particularly characterized by the fact that there are relatively often "useless" treatments. In order to ultimately have helped a few affected people, we have to treat many of them. Some patients might decide that they find the risk of experiencing side effects inappropriately high; others would take anything as a matter of course to increase their chances of recovery just a little. In order to be able to make an informed decision, some patients want us to explain their individual risk of dying of relapse in the next few years after cancer surgery, and they want to hear how much it is reduced when they take adjuvant therapy to take. We cannot name such numbers precisely for all constellations, but we ask ourselves these questions.

Calculation example

Background: From a statistical point of view, some diseases unfortunately relapse after some time, despite a full operation, often with daughter tumors that ultimately lead to death. It is assumed that this is caused by cancer cells that have detached themselves from the tumor long before the disease was discovered and before the first treatment step (before the operation) and that are "dormant" and undetectable as single cells and that were not recorded before the operation are.

After the supposedly saving operation, it is therefore not possible to tell from the individual patient whether he is the one in whom such an undetectable slightest scatter had already taken place. Because adjuvant therapy is used precisely when no tumor can be detected using conventional methods, it is also in principle never possible to measure whether it is fulfilling its purpose.

It is of great importance with adjuvant chemotherapy that no promises can be made as to whether they will be useful in individual cases. The fact that they are offered is always the result of statistical evidence that they could in principle (on a statistical average) be useful. This means that there are patients whom we treat adjuvantly, but who nevertheless later relapse, that there are a large number of those treated whom we treat (and who have side effects!) Who never relapsed even without this treatment would have. Another problem is that, unfortunately, the number of those who do not get the relapse through prevention that would have caught them without prevention - in comparison to the number of those "unsuccessfully" or "unnecessarily" treated is often not too high.

A numerical example: relapse rate 18% = out of 100 patients who have undergone surgery, 18 will have died of a relapse in 5 (or 10 or 15) years. If all 100 receive adjuvant therapy that lowers the relapse rate by 33%, then of the 18 who would otherwise have died, 6 [= 33% of those 18] will not have any relapse. 12 will still have it. 82 would never have had to be treated, 94 (!) Had no benefit from the treatment. Our problem: We never know beforehand which the 6 will be. Therefore we have to treat all 100, 94 of them "for free".

When chemotherapy is adjuvant, there is usually an obligation associated with dose and timing: There are older scientific evaluations that have shown that adjuvant chemotherapy for breast cancer only achieved the statistically promised improvements in healing if no significant compromises were made with the dose density had been received. This means that the patients had to receive the full amount of medication despite the side effects and that the interval between the next dose was not extended - the average dose per time could not be reduced at will. The option to treat "more gently" by decreasing the dose and or allowing more time to recover ("My oncologist is so compassionate ...") clearly had to be exposed as the worse treatment. There are newer approaches, also again with breast cancer, where attempts are made not to increase the dose of the adjuvant therapy, but to increase the dose density by reducing the time intervals between the infusions from three to two weeks. It's going in the same direction. It is believed that this principle also applies to other chemotherapy protocols used with adjuvant intent against other diseases such as colon cancer or bronchial cancer.

Neoadjuvant Therapy

Now it gets so complicated that even many doctors don't use the term correctly. What is meant is: You reverse the sequence of the types of treatment and do not start as always. You start with the adjuvant (see above) treatment, so to speak, and only carry out the classic and usually most effective method (usually the surgery) in the second step.

Example rectal cancer

It becomes clearest with the example: If you previously operated on rectal cancer and then called the radiation therapist so that he can do a subsequent additional treatment for better safety (an adjuvant therapy - see above), the experience is now that the results overall Get better if, as the first step, a mixture of radiation and chemotherapy is given and only then is done what was otherwise the same, namely an operation. In the example, radiation or its combination with chemotherapy can be described as "neoadjuvant" therapy. The effectiveness of neoadjuvant therapy can be measured in individual cases by the fact that the tumor has already receded before the operation. In this respect, it differs significantly from adjuvant therapy.

Consolidation Therapy

This less common term is mostly used when an initial treatment (usually surgery) is clearly not enough to cure the tumor on its own, i.e. when it must be assumed with a very high probability or with complete clarity that a relapse will only be a matter of time will be. Then the "consolidating" measure used in addition would be the one with which the desired success can more likely be achieved together.

Examples

If during the operation of a prostate cancer that has grown far into the surrounding area at the time of diagnosis, the surgeon's observation, but not the analysis by the pathologist, shows that it has definitely been completely removed, it would have to be expected that remaining tumor cells first exist and secondly the starting point for become a relapse. Then it is sometimes decided to ensure the success of the operation by means of radiation therapy, which is then called consolidating.

Similar considerations very often apply, for example, to the use of chemotherapy after major surgery for ovarian cancer, which is almost never enough on its own.

Curative therapy

This term is not used to describe an order. Rather, it should be emphasized that the treatment or treatment sequence in question (which can also be a combination of surgery and radiation and chemotherapy, not always just one type of treatment) can realistically achieve the goal of healing.

Hidden in this term is the consideration that in favor of such a goal (which is valued and valued as a priority), in some cases a patient also has to accept disadvantages (less important than that) from the therapy.

Palliative / palliative intended tumor therapy

Compared to curative therapy (goal: healing), a distinction is made between the situation in which it is unlikely that a cure can be achieved through active measures directed against the tumor (surgery, radiation, chemotherapy, hormone therapy, antibodies ...): The palliative intended Therapy is an active treatment directed against the malignant cells and tissues and its aim is to improve the situation even when a cure is not expected.

Not healing, but other goals

It is then about various goals such as alleviating symptoms, extending life, maintaining or improving the quality of life, postponing infirmity. At first, one often thinks that it is clear that all strength should be used to live as long as possible. But you soon realize that a weighing process is required. Successes against the disease can be achieved, but they may have to be bought with disadvantages: for example, side effects of chemotherapy could be the price for an extension of life. Here, the doctor and the patient must weigh up in each individual case whether the disadvantages of the therapy should or “must” be accepted.

In principle, it usually revolves around the question: Are side effects likely and are they in an individually acceptable relationship to the statistically expected gain in life and quality of life? Or: is it certain that the treatment is not worse than the disease? It is obvious that those affected have different assessments in different life situations. It is not uncommon for younger cancer patients to fight harder for lifelong gains, and older ones place maintenance of well-being over time.

What palliative therapy is not

Very important: The term “palliative therapy” does not mean that the patient is given up. Not seeking a cure does not mean that the treatment is not worthwhile at all. Neither does pallitively intended oncological treatment mean that the oncologist thinks the patient is about to die. It may also be that in spite of the "only" palliative approach, the oncologist expects that the patient can live with the cancer and one day will not die from it, but with it: We would like to point out that oncologists use this term (" palliative ") correctly, even if they treat without claiming to be cured for that reason alone, because it is not to be expected that the malignant suffering will lead to death anyway. After all, there are not uncommon situations in which one can expect that a patient will live to be the same age despite a malignant condition as without it. What one often does not realize is that some cardiovascular diseases pose a greater threat than some cancers. This is especially true for some prostate cancers and so-called "senile leukemia" (CLL), which may never require therapy for a lifetime.

Palliative medicine / "palliative care" / palliative medical care

While the oncological term "palliative intended tumor therapy" [s. last paragraph] describes that the treatment measures are directed against the malignant disease (without a cure being expected), a confusingly similar name has become common, which stands for a completely different approach:

Behind the term "palliative medicine" or "palliative care" or "palliative medical care" stands the basic attitude that the most seriously ill [and this does not only apply to cancer patients] and their caring environment in their last phase of life are most appropriately supported by having everything refrains from making symptoms worse and does everything possible to alleviate symptoms. "Making the last few meters as easy as possible" may describe the posture. Of course, this cannot be limited to optimal pain therapy, but it does play a major role. Spiritual and psychosocial aspects must be taken into account - the comprehensive view is also directed towards the environment of the person approaching the dying process. As a rule, these treatments, which are primarily aimed at agonizing symptoms, affect short periods at the end of life. Palliative medical care does not fundamentally exclude oncological treatment measures intended to be palliative, but as a rule it comes at a point in time at which any measure directly directed against the malignant disease has become meaningless because the disadvantages would completely outweigh the disadvantages.

Palliative Care is an “approach to improving the quality of life of patients and their families faced with problems such as those associated with a life-threatening disease, by preventing and alleviating suffering, through early detection, correct assessment and treatment of Pain and other distressing ailments of a physical, psychosocial and spiritual nature ”is the definition by the WHO from 2002.

Since the specialized outpatient palliative care SAPV was legally introduced in Germany in 2007, the possibilities of palliative medical care have been steadily expanded. For the catchment area of ​​our practice it has long been (2018) established - as it actually is for the whole of Hamburg - that a comprehensive supply of palliative medical offers for at home, in the nursing home, in the hospice or in inpatient palliative units is guaranteed. Most of the oncologists in our group are also palliative medicine specialists, the Albertinen Hospital has a palliative care unit, and we can care for patients at home as part of the PCT ("palliative care team").

BSC "best supportive care"

When the options of palliative intended therapy [see above] are exhausted to the extent that the doctor realizes that every possible further active measure directed against the tumor (cell toxins, radiation, surgery ...) would only harm the person more than it would be of good use, he will try to therefore not to “give up” his patient. Supportive, i.e. supportive, other measures are definitely possible, such as pain therapy or blood transfer. "Best supportive care" thus describes that care is aimed at offering the most suitable medical support in each case.

The conceptual separation from palliative medicine is fuzzy. Supportive therapy can be transformed into palliative care. As a rule, we use the term "best supportive care" when it is not about to die, but it can be clearly seen that any known tumor therapy should be avoided because it would do more harm than good. "They can't do anything for me" would be the wrong perspective. "Support when symptoms require it, otherwise you don't need to do much at the moment" better describes the underlying attitude.

Supportive therapy - another overlapping of terms

The concept of support does not only play a role after the measures aimed directly against the malignant disease have been exhausted. Supportive drugs are, for example, the group of drugs that are prescribed during chemotherapy to reduce undesirable effects - especially drugs against nausea, against diarrhea, to stimulate white (defense) blood cells, to protect the skin, to protect the Bladder mucosa, prophylaxis against viral diseases or against bacterial infections, to protect the oral mucosa, to treat infections, or to prevent drug allergies. Blood or platelet transfer due to anemia or loss of platelets due to chemotherapy are also common supportive measures.
 

By Oncology Partner Hamburg