Although more than half of all
cancer patients can look forward to long-term disease-free survival, there are
still thousands of cancer patients in the United States annually whose disease
progresses to where cure is no longer feasible. Treatment options referred to as
"palliative care" must then be
considered. The objective of palliative
care is to maximize survival time, or to decrease pain and suffering, thereby
enhancing the remainder of the patient's life. Palliative care may involve
surgery, chemotherapy, radiation therapy, or other approaches to managing
cancer. It may include
optimizing supportive care with medications to control pain, nausea, or other
troublesome symptoms.
If the patient does not wish to consider active treatment options such as surgery, chemotherapy, or radiation treatment, it may be worthwhile to consider the option of hospice management. Hospice is supportive care directed at making a terminally ill patient as comfortable as possible. In a hospice care situation, the patient may be maintained either in his or her own home or in an extended care facility with direct care provided by a visiting nurse in consultation with a physician.
In-depth
Information
The three major branches of
cancer treatment—surgery, radiation oncology, and medical oncology—offer
different options to the patient with advanced cancer. Surgery, for example, might provide a bypass
operation for a patient with advanced colorectal cancer completely obstructing
the bowel. Bypassing the
obstruction would permit the patient’s gastrointestinal tract to function
again. Medical oncology offers a patient
with metastatic breast cancer the combination of chemotherapy and hormonal
therapy to gain several months to a few years of additional useful life.
Radiation oncology also provides options for various advanced cancer problems.
Several of these are discussed below.
Bone Metastases
The spread to bone of a primary cancer such as breast cancer, prostate cancer, or lung cancer, may be a particularly painful and disabling problem. Apart from the problem of pain, the threat of fracture of a weakened bone may restrict the patient to a wheelchair or bed for the remainder of his or her life. For this reason palliative radiation therapy is often recommended for patients who have bone metastases in a major weight-bearing structure such as a hip or the spine. It is usually possible to treat such problems over a 2 or 3-week period with an 80% likelihood of a worthwhile response.
External beam
radiation treatment is a long-established approach to the problem of bone
metastases, but additional therapies may be useful in certain cases. These
therapies would include certain medications
referred to as bisphosphonates which act to promote uptake of calcium into
bones, and also systemic radiotherapy, in which a radioactive
isotope of strontium or samarium is injected and concentrates in multiple areas
of bone metastasis at the same time.
Brain Metastases
Spread to the brain is one of the most feared complications of cancer, and with good reason. The average survival for all patients with brain metastases is only one month without treatment, and six months with treatment. Radiation treatment of the whole brain is recommended to patients with brain metastases to gain this modest improvement in average survival and also to relieve symptoms. Steroids, such as dexamethasone, are also useful for improving symptoms.
It should be kept in mind that an individual patient may do better or worse than the average. A small number (10-15%) of patients with brain metastases will respond very well and remain in good functional condition longer than a year. A patient with a single brain metastasis may be offered a combination of surgical resection of the metastasis and whole brain radiation treatment, or a special technique known as stereotactic radiosurgery, which is available at Emory. Patients selected for these treatment options must fit certain profiles and will have an average survival of about one year. Research suggests that it may be possible to extend this option to patients with up to four metastases in the brain. Other patients with more than four metastases may be treated with radiation therapy to the whole brain, possibly with the addition of stereotactic radiosurgery to the known sites of disease.
Spinal Cord Compression
Spinal cord compression is the
second major neurological complication of cancer as it spreads or
metastasizes. Damage to the spinal cord
threatens to paralyze the patient so that he or she becomes confined to bed or a wheelchair. It can also deprive a patient of bladder or bowel control.
A course of radiation treatment directed to
the involved section of the spine may be able to arrest or even reverse these
debilitating neurological symptoms. If
changes are rapidly progressing, it may be desirable to start
treatment emergently.
Superior Vena Cava Syndrome
Superior vena cava syndrome is viewed as a radiotherapy emergency. This situation often develops as a consequence of the growth of lung cancer or lymphoma in the upper and central part of the chest. The tumor invades or compresses the superior vena cava, which is the major vein returning blood from the upper body to the heart. Common symptoms include: acute shortness of breath; swelling of the head, neck, and arms; flushing of the face and neck; chest pain; and cough.
It is often desirable to initiate radiation treatment quickly with two or three large doses of radiation. The overall treatment plan will depend upon the nature of the tumor and its stage. Superior vena cava syndrome is a life-threatening situation that usually requires rapid palliation of symptoms, but it is sometimes still possible to construct a potentially curative treatment plan depending on the specifics of the patient's disease.
Frequently Asked Questions Is there any chance my cancer can still be cured?
For most
patients referred for palliative radiation treatment, the answer will be,
unfortunately, no. There may be
occasional situations in which our physicians are aware of a new
treatment protocol at Emory or elsewhere that may give some hope of cure.
If I can’t be cured, why should I bother getting any
kind of treatment?
Even if a patient can’t be cured,
it may be possible to prolong survival or reduce
troublesome symptoms such as pain. For
example, hormonal therapies for advanced prostate or breast cancer may provide a
few more years of good quality life.
Research & Clinical Trials
IMRT
(Intensity Modulated Radiation Therapy) techniques to achieve improved
palliation are being investigated at Emory University.
Click here to visit the IMRT section of this
web site.