Cancer treatment
Cancer treatments are a wide range of treatments available for the many different types of cancer, with each cancer type needing its own specific treatment.[1] Treatments can include surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy including small-molecule drugs or monoclonal antibodies,[2] and PARP inhibitors such as olaparib.[3] Other therapies include hyperthermia, immunotherapy, photodynamic therapy, and stem-cell therapy.[4] Most commonly cancer treatment involves a series of separate therapies such as chemotherapy before surgery.[4] Angiogenesis inhibitors are sometimes used to enhance the effects of immunotherapies.[5]
Cancer treatment
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The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient. Biomarker testing can help to determine the type of cancer, and indicate the best therapy.[6] A number of experimental cancer treatments are continuously under development. In 2023 it was estimated that one in five people will be diagnosed with cancer at some point in their lifetime.[1]
The primary goal of cancer treatment is to either cure the cancer by its complete removal, or to considerably prolong the life of the individual. Palliative care is involved when the prognosis is poor and the cancer termed as terminal. There are many types of cancer, and many of these can be successfully treated if detected early enough.[1]
Special circumstances[edit]
In pregnancy[edit]
The incidence of pregnancy-associated cancer has risen due to the increasing age of pregnant mothers.[63] Cancers may also be detected incidentally during maternal screening.[63]
Cancer treatment needs to be selected to do least harm to both the woman and her embryo/fetus. In some cases a therapeutic abortion may be recommended.
Radiation therapy is out of the question, and chemotherapy always poses the risk of miscarriage and congenital malformations.[64] Little is known about the effects of medications on the child.
Even if a drug has been tested as not crossing the placenta to reach the child, some cancer forms can harm the placenta and make the drug pass over it anyway.[64] Some forms of skin cancer may even metastasize to the child's body.[64]
Diagnosis is also made more difficult, since computed tomography is infeasible because of its high radiation dose. Still, magnetic resonance imaging works normally.[64] However, contrast media cannot be used, since they cross the placenta.[64]
As a consequence of the difficulties to properly diagnose and treat cancer during pregnancy, the alternative methods are either to perform a Cesarean section when the child is viable in order to begin a more aggressive cancer treatment, or, if the cancer is malignant enough that the mother is unlikely to be able to wait that long, to perform an abortion in order to treat the cancer.[64]
Society and culture[edit]
Racial and social disparities[edit]
Cancer is a significant issue that is affecting the world. Specifically in the U.S., it is expected for there to be 1,735,350 new cases of cancer, and 609,640 deaths by the end of 2018. Adequate treatment can prevent many cancer deaths but there are racial and social disparities in treatments which has a significant factor in high death rates. Minorities are more likely to receive inadequate treatment while white patients are more likely to receive efficient treatments in a timely manner.[65] Having satisfactory treatment in timely manner can increase the patients likelihood of survival. It has been shown that chances of survival are significantly greater for white patients than for African American patients.[65]
The annual average mortality of patients with colorectal cancer between 1992 and 2000 was 27 and 18.5 per 100,000 white patients and 35.4 and 25.3 per 100,000 black patients. In a journal that analyzed multiple studies testing racial disparities when treating colorectal cancer found contradicting findings. The Veterans administration and an adjuvant trial found that there were no evidence to support racial differences in treating colorectal cancer. However, two studies suggested that African American patients received less satisfactory and poor quality treatment compared to white patients.[66] One of these studies specifically was provided by the Center for Intramural Research. They found that black patients were 41% less likely to receive colorectal treatment and were more likely to be hospitalized in a teaching hospital with less certified physicians compared to white patients. Furthermore, black patients were more likely to be diagnosed with oncologic sequelae, which is a severity of the illness in result of poorly treated cancer. Lastly, for every 1,000 patients in the hospital, there were 137.4 black patient deaths and 95.6 white patient deaths.[67]
In a breast cancer journal article analyzed the disparities of breast cancer treatments in the Appalachian Mountains. African American women were found to be 3 times more likely to die compared to Asians and two times more likely to die compared to white women.[68] According to this study, African American women are at a survival disadvantage compared to other races.[69][68] Black women are also more likely to receive less successful treatment than white women by not receiving surgery or therapy. Furthermore, The National Cancer Institute panel, identified breast cancer treatments, given to black women, as inappropriate and not adequate compared to the treatment given to white women.[70]
From these studies, researchers have noted that there are definite disparities in the treatment of cancer, specifically who have access to the best treatment and can receive it in a timely manner. This eventually leads to disparities between who is dying from cancer and who is more likely to survive.
The cause of these disparities is generally that African Americans have less medical care coverage, insurance and access cancer centers than other races.[71] For an example, black patients with breast cancer and colorectal cancer were shown to be more likely to have medicaid or no insurance compared to other races.[67] The location of the health care facility also plays a role in why African Americans receive less treatment in comparison to other races.[71][67] However, some studies say that African Americans don't trust doctors and don't always seek the help they need and this explains why there are less African Americans receiving treatment.[72] Others suggest that African Americans seek even more treatment than whites and that it is simply a lack of the resources available to them.[72] In this case, analyzing these studies will identify the treatment disparities and look to prevent them by discovering potential causes of these disparities.
Public perception[edit]
Despite recognition of improvements in outcomes, visceral fear of the disease is ubiquitous, and people may have to struggle to control it.[73]
Among lung cancer patients, stigma, shame, social isolation, and discrimination are common.[74] Such patients are sometimes told that they deserve cancer because of their smoking. Those patients also may have feelings of guilt for having cancer.[75][76][77] Stigma in cervical cancer was predominantly driven by fear of social judgment and rejection, self-blame, and shame, with notable negative influences from gender and social norms, as both human papillomavirus infection and cervical cancer were stigmatized due to the perception that they arise from reckless behavior such as having multiple sexual partners or neglecting screening.[78] Resilience may be a potent protective mechanism against stigmatization.[79] Resilience in context of cancer treatment is patient's physiological and psychological capacity to effectively adapt, recover, and maintain optimal functioning in the face of the medical challenges. It encompasses the ability to cope with and overcome adversity, maintain emotional well-being, and promote overall health and healing.[80]