Cancer Treatment: Goals and Follow-up

Question 1

What are some of the aspects of the patient-doctor interaction regarding cancer?

Answer 1

What are the patients symptoms?
What investigations are necessary? biopsy, histology, ICH, EM, US/CT,
How much does the patient want to be informed/involved?
What is the prognosis (often involves patient age, symptoms, performance status, extent of disease, co-morbidities)
What are the options and expectations of treatment?
What is involved in the patient management?
Is a trial of treatment appropriate?
Are there “trade-offs’ in treatment and is it worth it - are the side effects and loss of quality of life worth a limited time extension?
GENERALLY, PATIENTS PREFER TO FEEL BETTER THAN LIVE LONGER.

Question 2

List some of the possible tumour responses post treatment.

Answer 2

Complete remission - lesion has disappeared; partial remission (shrinkage by 20%); stable disease, progressive disease (unresponsive)

Question 3

What is gefitinib and what may cause a tumour to be unresponsive to it?

Answer 3

Gefitinib is an EGFR inhibitor (epidermal growth factor receptor), used in cancers such as advance NSCLC. However KRAS mutation will inhibit response, as downstream constitutively active pathway.

Question 4

What are the goals of follow-up after curative treatment?

Answer 4

Detection of recurrence, surveillance for new primary, detection of late complications of treatment, provision of psychological support. (cancer survivor ship should be a chronic disease model)

Question 5

List some common problems in cancer survivors.

Answer 5

late cardiac effects, cognitive impairment (chemo fog with trouble concentrating, poor memory), fatigue, neuropathy (irreversible numbness/tingling), anxiety, depression, endocrine deficiency.