Cancer Treatment: An Overview

What are the goals of cancer treatment?

Cancer treatment is not one-size-fits-all, and the goals of therapy may be different across individuals who require treatment. To personalize cancer treatment means to consider:

• the individual’s type of cancer; 

• the location and extent of disease;

• the unique molecular or genetic characteristics of both the cancer and the person, when applicable, and

• integrate these and other clinical aspects with the patient’s care goals and preferences to determine the most appropriate treatment approach.

The overall goal of cancer-directed therapy will generally fall under one of the following aims:

• To cure. When cancer is early-stage, or localized and has not spread, treatment will likely be given with a view to completely eradicating the cancer. In some situations, even when cancer has spread, it may still be curable.

• To reduce recurrence. After initial therapy has been given to remove the cancer, additional treatment may be given to decrease the chance of the cancer coming back. 

• To control the cancer (palliate) when a cure is not achievable. Many therapies work to keep cancer as small or low-level in the body as possible, for as long as possible, when disease is not able to be completely eradicated. Palliative cancer treatments may also be given to relieve pain or other symptoms caused by the cancer. 

What are the types of cancer treatment?

• Surgery may have a role in not only treating cancer, but also in diagnosing it, understanding the extent (or stage) of disease, palliating or relieving symptoms related to the cancer, and even in preventing cancer. Sometimes surgery is aimed at removing cancerous tumors entirely. Other times, surgery will remove as much cancer as possible, and another treatment will follow, to eliminate any tumor cells that are left.
  
  For certain cancers, depending on the stage and location of the disease, surgeons may be able to perform a minimally invasive procedure called laparoscopic surgery, using smaller incisions and the aid of a camera. Laparoscopic surgery generally results in shorter hospital stays than an open surgery, and the recovery time is typically shorter.

• Radiation therapy, or radiotherapy, kills cancer cells using high-intensity beams of energy, usually x-rays. Radiation therapy is commonly delivered using a machine that targets the tumor very precisely from outside the body, which is called external beam radiation therapy. Another type of radiation therapy, brachytherapy, is internal, which involves inserting radiation-emitting sources (like seeds or catheters) directly inside the body, in or very near the tumor.

• Chemotherapy is cytotoxic or cell-killing medicine commonly given through an intravenous infusion into the bloodstream, though it can sometimes be given by other routes, like by mouth or in a pill form. A hallmark of cancer cells is that they can rapidly divide to grow and spread, and because chemotherapy generally affects actively dividing cells in the body, it is an effective treatment for many cancers. There are many different types of chemotherapy, and an agent that works in one type of cancer may not be effective in another type.

• Immunotherapy is also a systemic therapy because it goes throughout the body system and is usually delivered via an infusion. Immunotherapy works by harnessing the body’s own natural defenses (the immune system) to fight cancer. Types of cancer immunotherapy include:
   
  • Immune checkpoint inhibitors. These medicines ‘take the brakes off’ the immune system, allowing the patient’s own immune cells to see and kill cancer.
    
  • Chimeric antigen receptor (CAR)-T cell therapy. This is a form of personalized immunotherapy where the patient’s immune cells (T cells, a type of white blood cells) are modified to become potent cancer killer cells against that person’s particular cancer. CAR-T cell therapy can be very effective for people with certain types of blood cancers and is currently being studied in clinical trials in many other types of cancer. It does have significant risks and can cause severe side effects, and patients undergoing CAR-T therapy must be very closely monitored, usually for multiple weeks, during and after therapy.
    
  
  
• Hormone therapy, also called endocrine therapy, is often used to treat cancers that rely on hormones to grow, such as certain types of breast cancer or prostate cancer. Hormone therapy is commonly given by injection or taken by mouth in pill form.
• Hematopoietic stem cell transplantation (HSCT, sometimes also known as bone marrow transplant) may be used to treat some people with blood cancer (such as certain types of leukemia, lymphoma, or multiple myeloma), testicular cancer, or certain brain cancers. A stem cell transplant replaces the patient’s diseased system (starting with the bone marrow, which is the blood factory) with a brand new ‘starter’ system of stem cells, or precursor cells that are anticipated to mature and produce healthy cells. The stem cells can either come from the patient themself (this is called an autologous HSCT), or from a related or unrelated matched donor (this is called an allogeneic HSCT).
  
  Stem cell transplant has become an important part of cancer treatment for many people since it was pioneered in the 1970s at NCI-designated Comprehensive Cancer Centers including AccessHope partners City of Hope and Fred Hutchinson Cancer Center.
  

3. Precision Oncology

Precision medicine or precision oncology customizes cancer treatment based on knowledge of how the disease is influenced by each person’s unique genes, environment, and lifestyle, as well as the specific molecular or genetic alterations driving the cancer.

The genetics of both the patient and the cancer itself, in other words, may influence treatment decisions. The goal of precision oncology is to select, when possible, the most exact or accurate therapy for a particular person facing a particular cancer.

Two types of genetic testing are often utilized in precision oncology:

• Tumor genetic testing. Also known as next-generation sequencing, tumor molecular profiling, somatic profiling, or somatic testing, this type of genetic testing involves obtaining a tumor sample (biopsy) or sometimes a blood sample for circulating tumor cells (‘liquid biopsy’) to look for mutations or alterations that ‘turn the cancer on’ and make it grow. If such an alteration is found, it is often called a driver mutation and the search for a treatment that targets that driver mutation begins, with a goal of turning it off so that the cancer can no longer grow.
  
• Germline genetic testing. This type of testing involves obtaining a sample of the patient’s blood or saliva to analyze their inherited genes. Often done alongside a consultation with a genetic counselor who will obtain a detailed family history, germline testing looks for abnormalities that may be passed down through the family line. If a germline abnormality (mutation) is detected that is associated with an increased cancer risk, this has implications not just for the patient, but for their family as well. The presence of a germline mutation may inform the most precise cancer treatment options for the patient, as well as guide them and their family on the need for heightened screening and prevention measures.

What can be expected if cancer treatment is needed?

Side Effects

While some degree of fatigue is common with many cancer treatments, the potential side effects and complications one might anticipate from cancer treatment depends on the specific type of therapy prescribed. Undergoing treatment for cancer can take both a physical and emotional toll, and consulting with your care team will equip you with the most useful information on how to prevent, monitor, and manage any anticipated side effects specific to your treatment. Your care team will also advise when to call your doctor or seek emergency medical attention.

Practical Considerations

Common concerns around cancer treatment may include how much it will cost, transportation to/from appointments, how to care for children, other dependents, or pets during treatment, how to attend to other self-care needs, and whether time away from work will be required. Many resources are available to assist people facing cancer and their families/caregivers, and the best place to start is to share any concerns with your care team.

Supportive Care

Supportive care encompasses a multitude of ancillary services or treatments that may be offered alongside cancer-directed therapy that are aimed at preventing or mitigating the physical and/or emotional burden cancer can have on the person and their family/caregivers. 

Supportive care may include a dietician for optional nutrition, a medical social worker or spiritual counselor for emotional and psychosocial support, physical or rehabilitative therapists, a care manager to help coordinate care across different settings, and/or medical subspecialists in palliative medicine and hospice, who are skilled in the management of complex symptoms and provide multidimensional care in the setting of serious illness, to name a few. Different elements of supportive care may be helpful at different time points during a person’s cancer journey. The goal of supportive care is to optimize quality of life for people facing cancer and help them thrive, not simply survive, during their cancer experience.

Advance Care Planning

Planning for future healthcare is also important, and discussing any preferences with loved ones as well as with the care team is vital to ensure treatments are aligned with the patient’s personal values and care goals. Documentation of personal wishes for future healthcare in an advance care directive or living will may also help patients and families gain peace of mind. Members of the cancer team and/or a supportive care team can help navigate conversations around advance care planning with patients and families, and individuals facing cancer are always encouraged to be proactive and enquire about it if their doctor does not bring it up first.

Cancer Research & Clinical Trials

Cancer research is moving at a rapid pace, with new discoveries being made and novel treatments emerging faster than ever before. Clinical trials, which are an integral part of cancer research, involve eligible, consenting individuals who participate in an organized study of promising new diagnostic, therapeutic, or survivorship approaches. Clinical trials may ultimately benefit not just the individuals on the study, but the larger population, and at a minimum, advance knowledge that furthers our progress in the fight against cancer.

Optimal Cancer Care

Cancer therapeutics have never been more effective, and the ongoing intensive efforts in the research laboratory and in clinical trials promise to continue us on this trajectory. While this is exiting and can be transformative, several factors may lead to delays in deploying the latest advances across the wider U.S. cancer population.

The gap between cancer discovery and the implementation of new advances into clinical practice everywhere may result in some people not receiving the best possible treatment for their cancer. Every individual facing cancer deserves awareness and access to the most suitable cancer treatments and/or clinical trials for their unique situation. Furthermore, optimal cancer care comprises not just cancer treatment, but many other aspects of care, such as supportive measures, that promote the well-being of the patient and their family/caregiver.

The National Cancer Institute (NCI)-designated Comprehensive Cancer Centers (NCI-CCCs) lead the nation in cancer discovery and delivery of comprehensive care in a multidisciplinary setting. NCI-CCCs have achieved ongoing recognition from the National Cancer Institute for maintaining rigorous standards for state-of-the-art cancer research involving a well-coordinated combination of high-quality laboratory research, population science, and clinical research.

Studies have shown that patients receiving care at NCI-CCCs have superior survival outcomes, which is attributed to the prolific research and clinical trials offered at these centers as well as the disease-specific expertise of the oncologists, multidisciplinary teams, and resources at NCI-CCCs. There are currently over 50 NCI-CCCs, including AccessHope partners City of Hope, Dana-Farber Cancer Institute, Winship Cancer Institute of Emory University, Fred Hutchinson Cancer Center, and Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

How Does AccessHope Contribute?

Comprehensive insights by oncology subspecialists from AccessHope’s network of NCI-CCCs into a patient’s multifaceted treatment plan may help bridge the cancer knowledge gap and facilitate optimal cancer care for that person. AccessHope offers individualized insights and recommendations to patients and their treating oncologists with the aim of knowledge-sharing and partnering to improve outcomes and quality of life for patients, no matter where they live.

AccessHope's Cancer Support Team

• The AccessHope Cancer Support Team is comprised of compassionate people with deep experience in cancer care, such as oncology nurses. They’re eager to listen. They’re ready to provide emotional support. And they’re prepared to address questions and provide information and resources on, for example, how to prepare for doctor’s visits, what to expect from cancer treatment, how to manage side effects, and live life well, with cancer.
• The Cancer Support Team is also proactive in connecting patients with other benefits that might be available to them. 
• No matter where a person is in their cancer experience, the Cancer Support Team is as close as a phone call or an easy online appointment, free of charge and with no limit to the number of calls that can be made along the journey.
  

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