What is the comprehensive approach to cancer management?

Comprehensive Approach to Cancer Management

A multidisciplinary team-based approach is the cornerstone of effective cancer management, integrating surgery, radiotherapy, systemic treatments, and supportive care to optimize patient outcomes in terms of morbidity, mortality, and quality of life. 1

Multidisciplinary Team Structure

• Cancer care should be delivered in specialized cancer units/centers by a multidisciplinary team consisting of medical oncologists, surgeons, radiation oncologists, radiologists, pathologists, and specialized nurses 1
• The cancer unit should have access to or be able to refer patients to plastic/reconstructive surgeons, psychologists, physiotherapists, and geneticists when appropriate 1
• A specialized nurse or healthcare practitioner should be available to act as a patient navigator throughout the cancer journey 1

Diagnosis and Assessment

• Comprehensive pathology reporting using standardized protocols (such as College of American Pathologists protocols) is essential for quality cancer care 1
• Initial assessment should include determination of disease stage, estimation of recurrence risk, and evaluation of predictive biomarkers that guide treatment selection 1
• Genetic counseling is recommended for patients at high risk for hereditary cancer syndromes 1
• Imaging studies should be selected based on cancer type and suspected extent of disease, potentially including CT, MRI, bone scans, and PET/PET-CT 1

Treatment Planning

• Treatment decisions should be based on tumor burden/location, tumor biology (including biomarkers), patient age, menopausal status (if applicable), general health status, and patient preferences 1
• Age alone should not determine treatment recommendations but should be considered alongside other factors 1
• Fertility preservation options should be discussed with younger patients before initiating systemic treatments 1

Treatment Modalities

Surgery

• Surgical approaches have shifted toward more conservative techniques when possible, with approximately 60-80% of breast cancers being amenable to breast conservation techniques 1
• Neoadjuvant (pre-surgical) therapy should be considered for certain cancer subtypes that are highly sensitive to chemotherapy 1

Radiation Therapy

• Radiation therapy contributes to approximately 40% of curative cancer treatments 2
• The primary goal of radiation therapy is to deprive cancer cells of their multiplication potential 2
• Re-irradiation to limited areas may be considered in previously irradiated patients after careful risk-benefit assessment 1

Systemic Therapy

• Endocrine therapy is preferred for hormone receptor-positive disease unless rapid response is needed or endocrine resistance is suspected 1
• HER2-directed therapy should be offered early to all HER2-positive breast cancer patients 1
• Sequential monochemotherapy is preferred in metastatic disease without rapid progression or life-threatening visceral metastases 1
• Docetaxel is FDA-approved for multiple cancer types including breast, non-small cell lung, prostate, gastric, and head and neck cancers 3

Rehabilitation and Supportive Care

• Rehabilitation assessment and interventions should be integrated into cancer care to address physical and cognitive impairments and manage treatment-related symptoms 1
• A prospective surveillance approach is recommended, with baseline measures of performance and function repeatedly monitored over time 1
• Psychosocial support from trained professionals should be available at all stages of the cancer journey 1
• Patient-reported outcomes should be regularly assessed to help evaluate treatment impact and monitor symptoms requiring intervention 1

Follow-up and Surveillance

• Follow-up after curative treatment should include regular clinical assessments to provide optimal palliation of symptoms and maintain quality of life 1
• Imaging surveillance should be tailored to the cancer type and risk of recurrence 1
• Patients should be instructed to contact their physician immediately if symptoms suggestive of disease progression or treatment complications develop 1
• Patients are at increased risk of developing second primary cancers (1.5-2% per year for lung cancer survivors) and may benefit from appropriate screening 1

Patient Information and Involvement

• Information on diagnosis and treatment options should be provided repeatedly, both verbally and in writing, in a comprehensive and easily understandable form 1
• Patients should be actively involved in all management decisions 1
• Reliable, patient-centered information sources should be recommended 1
• Patients need clear information about the purpose of different treatments, potential side effects, and impact on functional, emotional, and social well-being 1

Common Pitfalls and Challenges

• Administrative barriers can limit implementation of integrated models of care and should be addressed at the organizational level 1
• Guideline implementation is often challenged by real-world clinical practice limitations including staffing, workforce knowledge, clinical workflows, and program sustainability 1
• Patients may not receive appropriate rehabilitation services if functional assessments are not properly linked to referral pathways 1
• Monitoring response to treatment can be challenging in patients with non-measurable disease 1

By implementing this comprehensive approach to cancer management, healthcare systems can optimize outcomes for cancer patients in terms of survival, function, and quality of life.