How is cancer treated?

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Standard and non-standard therapy

Cancer treatments can be classified as either standard or non-standard treatments, depending on whether or not they are typically recommended to treat the patient’s type of cancer.1

Standard of care

Standard of care might also be called best practice treatment. It is the treatment that experts accept is most likely to be effective against a particular type of cancer, for the majority of patients. It is the treatment recommended in guidelines and the one approved by governments to treat a particular type of cancer.1

Where several treatments are accepted for treating a particular type of cancer, they might be further classified as first line, second line and third line treatment, based on the order in which they should be given to a patient. First line treatment is given initially, and if it is not effective then second line treatment will be given. Although the standard of care is the type of treatment that is most likely to be effective for the majority, it is not always effective.1

Genetic differences between individuals can mean that individuals absorb, distribute, metabolise and excrete anticancer drugs differently. This means that the same dose of a drug can be more effective in some patients than others.2 In addition, a patient’s response to treatment is complicated by the fact that no two tumours are identical, in that the mutations and other molecular changes present in the cancerous cells are different in different people.3  Patients’ experiences and tolerance of the side effects of treatment can also be influenced by their general health, how long they have been receiving treatment, other treatments they may be having, and the dose of any drugs they may be receiving.4

Off label or non-approved treatment

Patients whose cancer does not respond to the standard of care may try different, non-standard treatments. These may also be referred to as non-approved or off label treatments. They are treatments that are not generally recommended for that type of cancer, but which may be clinically appropriate if a doctor has evidence to suggest it might be more effective for that particular patient.5 Although the treatment is not recommended, as long as the drug is approved by a government regulatory body, doctors can legally prescribe non-standard or off label treatments.6

Most commonly, off label use involves the prescription of a medication which has been approved by a government regulatory body, but for a condition that it has not been approved for. Off label use can also involve prescribing a drug that is the best practice treatment for a condition, but at a dosage that is different to the best practice treatment and is not approved by a government regulatory body.7 Information is more limited about whether off label treatments will be effective and about the potential risks of the therapy.5 Unlike standard therapy, it may not be covered by health insurance schemes 6

Another way to access drugs that are new and may not  have been approved is by participating in clinical studies.

Types of anticancer treatment

Cancer treatments can be classified depending on how they work to fight cancer. There are many types of anticancer treatments available, and each may be used alone or in combination with other types of cancer therapies.8

Chemotherapy

Chemotherapy, commonly called ‘chemo’, is a type of anticancer treatment in which medicines are used to kill cancerous cells or interrupt their growth and replication (for more information see What is cancer?). There are many different chemotherapy drugs which have different effects on different types of cancer.9 For example, different medicines are used to treat breast cancer compared to ovarian cancer.

The medicines used in chemotherapy circulate throughout the body, which means that unlike surgery and radiotherapy, they can be used to treat cancers that have spread from their original site.10

Targeted therapy

Targeted therapy drugs target specific features of cancer cells which make them grow more quickly than healthy cells. For example, they may interfere with particular chemicals or proteins that drive the growth of cancer cells. This approach aims to minimise the harm caused healthy cells while maximising the attack on cancerous cells.11

Radiotherapy

Radiotherapy is a type of cancer treatment in which high doses of radiation are used to kill cancer cells. The radiation doses are administered to the cancer patient’s body using a special device and they destroy or prevent the replication of cancer cells. Although radiation also damages healthy body cells, the healthy cells can repair themselves, whereas the cancer cells cannot. Radiation therapy is used to treat cancer which occurs at a specific location in the body.12

Surgery

Surgery is a longstanding cancer treatment which aims to remove the cancerous cells of tumours from the patient’s body. It is most commonly used to treat cancer that is confined to a specific body organ. Ideally the entire tumour is removed. However, for some patients removing the entire tumour is too dangerous. For example, it might damage surrounding tissues or organs, so cancer surgery may involve the partial removal of a tumour.13

Biological therapy (immunotherapy)

Biological cancer therapies are those that use the patient’s immune system to fight their cancer. They are also called biotherapies or immunotherapies. They may stimulate their patient’s immune system to worker harder to fight the cancer, train it to recognise cancer cells better, or boost their immune system by administering synthetic (man-made) immune system components like monoclonal antibodies.14

Alternative and complementary therapy

Alternative and complementary cancer therapies are treatment approaches from non-medical disciplines, which are not subject to the stringent tests medicines undergo before approval. There is an important distinction between the two.15

Complementary therapies can be used in addition to conventional cancer treatments (treatments prescribed by your oncologist) to help cancer patients cope with their treatment and its side effects, and maintain a positive state of mind. Complementary therapies can include meditation, talking therapy and massage. Patients should always discuss the use of any complementary therapies with their doctor as they have the potential to interfere with conventional treatment.15

On the other hand, alternative therapies are therapies that have not been scientifically tested and are unproven to be effective. Alternative therapies can include homeopathy, naturopathy, Chinese herbs and megavitamins.15 Alternative therapies can cause harmful side effects and interact with conventional treatments, reducing their efficacy.16 Patients should never use alternative therapies instead of, or as well as, therapies that have been proven effective in the treatment of cancer.15 If patients have any questions or concerns they should discuss these with their doctor.

 

References

  1. Friends of Cancer Research. Standard of care. 2016 (cited 11 December 2016). Available from: [URL link]
  2. Undevia SD, Gomez-Abuin G, Ratain MJ. Pharmacokinetic variability of anticancer agents. Nat Rev Cancer. 2005;5(6):447-58. [Abstract]
  3. Marusyk A, Polyak K. Tumor heterogeneity: causes and consequences. Biochim Biophys Acta. 2010;1805(1):105-17. [Full text]
  4. Cancer Research UK. About side effects. 2014 (cited 7 May 2017). Available from: [URL link]
  5. Gazarian M, Kelly M, McPhee JR, et al. Off-label use of medicines: consensus recommendations for evaluating appropriateness. Med J Aust. 2006;185(10):544-8. [Full text]
  6. American Cancer Society. Off-label drug use. 2015 (cited 11 December 2016). Available from: [URL link]
  7. Wittich CM, Burkle CM, Lanier WL. Ten common questions (and their answers) about off-label drug use. Mayo Clin Proc. 2012;87(10):982-90. [Full text]
  8. Cancer Council Australia. Treatment. 2017 (cited 1 May 2017). Available from: [URL link]
  9. Cancer Australia. Chemotherapy. 2015 (cited 1 May 2017). Available from: [URL link]
  10. Cancer Council New South Wales. Common questions about chemotherapy. 2016 (cited 1 May 2017). Available from: [URL link]
  11. Cancer Australia. Targeted therapy. 2017 (cited 1 May 2017). Available from: [URL link]
  12. Wuellner L (ed). Understanding radiotherapy. Sydney: Cancer Council Australia; 2014. [Full text]
  13. Cancer Council Australia. Surgery. 2017 (cited 1 May 2017). Available from: [URL link]
  14. Cancer Australia. Immunotherapy. 2016 (cited 1 May 2017). Available from: [URL link]
  15. Cancer Council Australia. Complementary and alternative therapies. 2016 (cited 1 May 2017). Available from: [URL link]
  16. Cancer Research UK. The difference between complementary and alternative therapies (CAMs). 2014 (cited 7 May 2017). Available from: [URL link]
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