EULALEE THOMPSON
The current approach to cancer management wants to cut back on mutilating outcomes and improve the patient's quality of life.
TAKING CONTROL of your health also involves keeping up-to-date on the latest available treatment. In cases of cancer, Dr. Angella Scott, Senior Resident of Sub Department, Haematology, University of the West Indies (UWI), said that neoadjuvant therapy has become integral in the management of the disease.
She explained at the Medical Association of Jamaica's (MAJ's) annual conference last weekend that neoadjuvant therapy refers to a series of treatment, usually chemotherapy and/or radiation, given to the cancer patient before surgery to remove the tumour. In the traditional treatment, the tumour is removed first and then followed by chemotherapy and/or radiation. This shift in cancer management is aimed at improving the patient's quality of life and organ preservation.
"Both doctors and patients alike have felt the need for a better approach to management of their malignancies and hence the issue of organ preservation has become an important issue," Dr. Scott told health professionals attending the conference at the Jamaica Pegasus Hotel, New Kingston. "...It has been the approach that the wider the resection, the better the chance for a cure. However, this has left our patients with rather mutilating outcomes. There is loss of vital functions, inconvenient and sometimes embarrassing diversion procedures, leaving the patient with a quality of life which is sometimes less than what they would desire."
There appears to be ongoing research on the advantages and disadvantages of giving chemotherapy and radiation before or after surgery, but one study published in the Southern Medical Journal says, for example, that neoadjuvant therapy allows patients with large breast cancer to undergo breast-conserving surgery and patients with locally advanced laryngeal cancer to have their vocal function preserved; and, in certain cancers, neoadjuvant therapy may improve long-term survival.
Dr. Scott said that it is now standard of care to treat some tumours such as breast cancer, head and neck cancer, oesophageal cancer. Many other types of cancers are being investigated by medical scientists to determine if organ preservation/neoadjuvant therapy is beneficial to the cancer patient.
BREAST CANCER
In the case of breast cancer, Dr. Scott explained that medical science has been trying more radical surgery to improve the mortality rate, but morbidity rates only increased. In the 1960s radiation was added to treatment when it was noticed that there was "a reasonable sensitivity of the tumours to radiotherapy"; patients' quality of life improved with less surgery, that is, a lumpectomy (removal of the tumour) and radiation.
Several researchers indicate that neoadjuvant chemotherapy plays an important role in breast conservation. Removing only the lump from the breast (lumpectomy) followed by radiation treatment is said to give equivalent results to mastectomy (removal of the entire breast) when treating operable invasive breast cancer in women. When the tumours are large, however, it is difficult for surgeons to perform lumpectomy and in this situation, studies indicate that neoadjuvant chemotherapy may help reduce the tumour size, facilitating a lumpectomy versus a mastectomy.
A large U.S. study, conducted by the National Surgical Breast and Bowel Project, randomly assigned patients to groups that received chemotherapy before or after surgery. The researchers noticed no survival difference between the two groups but those women who received chemotherapy before surgery had 12 per cent more lumpectomies, instead of mastectomy due to tumour shrinkage than in the other group. The benefit was most pronounced in tumours larger than 5 cm.
Dr. Scott explained that breast conservation may not be appropriate in all cases, for example, in cases where there is:
1. A high probability of subsequent breast cancer (including patients with relatives who developed premenopausal breast cancer)
2. A high probability of complications
3. The possibility that cosmetic results are going to be poor and
4. Cancer phobia the patient prefers mastectomy for fear of cancer spread or return.
You can send your comments to eulalee.thompson@gleanerjm.com.
