How is Treatment for Cancer Decided ?
There are a number of treatment options for Cancer. The most common options of treatment include Surgery, Radiotherapy, Chemotherapy, Biological therapy,Immunotherapy and Supportive Care. There are a lot of other options of treatment used in specific settings of cancer.
Factors which determine which treatment or which combination of treatment is most appropriate for the patient are listed below. This will give an idea on the decision-making process of the Oncologist.
The biopsy result confirms the presence of Cancer and the type of cancer such as Lung cancer, Breast cancer etc. The result may also inform about the type of that cancer and any molecular or genetic changes. All of these results are very important to make a decision about treatment.
Stage of Cancer
As discussed in detail on this website, each cancer is given a stage based on its location and pattern of spread in the body. Most cancers are staged from 1 to 4, with stage 4 being very advanced or metastatic. Stage plays an important role in deciding on treatment options.
Patient’s Performance status
The fitness of the patient is one of the most important factors that is taken into account when deciding on the treatment for a cancer. The fitter the patient, the more options of treatment are considered. This fitness is assessed by estimating the performance status of the patient. There are different scoring systems such as WHO, ECOG and Karnofsky which help in this process. A WHO scoring system is given below.
WHO Performance status
|Grade||Explanation of activity|
|0||Patient is fully active, able to carry on all pre-disease performance without restriction|
|1||Patient is restricted in physically strenuous activity but mobile and able to carry out work of a light or sedentary nature like light house work, office work|
|2||Ambulatory and capable of all selfcare but unable to carry out any work activities. Patient is up and about more than 50% of waking
|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|
For patients who are performance status 3 or 4, treatment options will be limited irrespective of the stage of Cancer.
A decision on treatment options also depends on other co-existing illnesses of the patient. Commonly these include heart disease, kidney, liver, diabetes or other diseases. This is because these conditions may make Cancer treatments more toxic and difficult.
Patient choice plays a vital role in making treatment decisions. There are many instances in cancer treatment when two options are very similar in effectiveness but different in side effects. In those situations, it is up to the patient to decide which option they feel suits them most. This is done with the guidance of the doctor and the family. Some patients may choose not to have any treatment at all for their cancer and others may want all options pursued irrespective of consequences. Therefore, doctors take the choice of the patient into account when deciding on the treatment.
Finances and Cost Effectiveness
A choice of treatment may be determined by the treatment cost. Some treatment options are more expensive than others especially for fee paying patients. Cost effectiveness of treatments are also considered when making choices.