Today we will talk about the treatment of cancer patients, which results in recovery. Such a treatment is called radical in medicine. The oncologist, chemotherapist and head of the chemotherapy department of TomoClinic Oksana Fridman revealed us the essence of an individual approach in a treatment.
— The patient often wants to get some certainty before treatment, so he asks the doctors about the quantity of chemotherapy courses. Is there a clear answer to this question?
— Patients who have radical treatment also have the clear number of courses stated in the international ESMO and NCCN protocols. For example, after bowel surgery the patient is recommended a protocol with XELOX for six months.
— Does it happen that a patient has an “individual” pathway of antitumor therapy?
— The consilium is based on international protocols, but during treatment the scheme can be adjusted. We do not know how the disease or chronic diseases will manifest itself, how the patient will feel himself and how the chemotherapy will affect the body. For example, a patient with breast cancer receives doxorubicin, which has a high degree of cardiotoxicity. The treatment protocol may be reviewed due to the impossibility of taking such a drug, if she has heart problems. In some cases we reduce the dosage. There is also complete drug intolerance. Then it is necessary to cancel it, if it can lead to serious complications.
— What determines the number of chemotherapy courses?
— It depends on the diagnosis, stage of the disease, histology, tumor localization. Often the number of courses is associated with clinical studies, because according to their results they make international recommendations for the treatment of patients. The optimal course of treatment is selected to achieve maximum relapse-free and overall survival.
— What happens if chronic diseases begin to manifest themselves during treatment?
— Usually, the protocol is followed until the progression of the disease or intolerant toxicity. Therefore, it is important for doctors to monitor the clinical picture of the patient, it may worsen. If pain increases, ascites and shortness of breath appear, indicators of renal or liver failure increase, arrhythmia or blood sugar increases, then such a patient will not go to a new cycle of treatment. The council has to figure it out, find the cause of these symptoms, and if necessary, examine the person. The doctor must understand: is it a reaction to chemotherapy or an exacerbation (relapse) of chronic conditions? In the first case, we need to adjust the plan: cancel the drug in severe cases or reduce the dose. There should be a consultation of an adjacent specialist and symptomatic therapy. It is necessary to get the stabilization of condition, after that the antitumor treatment can be continued.
— Are there any cases when the patient has no need to follow the protocol if the body’s response to treatment is high?
— Compliance with the treatment scheme will give maximum disease-free survival. If there are no serious side effects and no critical decrease in the quality of life leading to disability, then the patient continues treatment according to the scheme, even if the tumor has disappeared. Complete all prescribed courses as a preventative measure.
— Who decides on the treatment scheme and its adjustment?
— When a patient arrives, the council evaluates his condition, approves the treatment protocol. However, experts always initially specify what dosage should be, what methods will help evaluate the body’s response to treatment and how they will analyze the effect of therapy. It is important to assess the patient’s condition in comparison with the previous one before each hospitalization: we observe his well-being, symptoms, complaints, tolerance, activity, analyzes. Standards are standards, but each patient is individual. Therefore, the treatment scheme will be individual regardless of the accepted treatment protocol.