What is the basic information I need to know about oncology?

Basic Information About Oncology

Oncology is a complex field requiring effective communication, comprehensive information sharing, and care planning to ensure optimal patient outcomes in terms of morbidity, mortality, and quality of life. 1

Core Components of Oncology Care

• Cancer is an emotionally laden, often disruptive experience for patients, families, and providers that requires good communication with emphasis on anticipatory planning 1
• The National Comprehensive Cancer Network (NCCN) provides comprehensive guidelines covering treatments for malignancies affecting 95% of all cancer patients, including specific disease management and supportive care areas 1, 2
• NCCN guidelines are developed by 45 panels comprising over 600 clinicians and researchers from 19 member institutions and are updated annually to incorporate new evidence 1, 2

Essential Components of Cancer Assessment

• A central component of breast cancer treatment is full knowledge of disease extent and biologic features, which help determine disease stage, estimate risk of recurrence, and predict response to therapy 1
• Minimal staging work-up for advanced cancer includes history and physical examination, hematology and biochemistry tests, and imaging of chest, abdomen and bones 1
• Pathology assessment requires communication between clinician and pathologist about relevant patient history, prior biopsies, radiation exposure, and specific requests to determine biomarkers 1

Treatment Approach

• Treatment of breast cancer includes local disease management with surgery, radiotherapy, or both, and treatment of systemic disease with endocrine therapy, chemotherapy, biologic therapy, or combinations of these 1
• The ultimate goal of cancer treatment is to cure disease through multimodality approaches directed at the primary tumor and potential metastases 3
• When cure is not possible, controlling cancer growth and spread may result in an equally acceptable outcome if it leads to what some experts term a "functional cure" 3

Communication and Information Sharing

• Discussions of diagnosis, prognosis, and treatment decisions are essential processes that inform decision making, with most patients desiring to participate in decisions regarding their own treatment 1
• The majority of cancer patients want to know their diagnosis and receive detailed prognostic information, though this varies between individuals and for a given individual over time 4
• Providing ranges for worst-case, typical, and best-case survival scenarios is more helpful and conveys more hope than providing a single point estimate of median survival 1

Advance Care Planning

• Advance care planning (ACP) is a key aspect of excellent supportive care that brings together patients, caregivers, and providers to develop a coherent care plan meeting the patient's goals, values, and preferences 1
• Legal standards, clinical guidelines, and ethical consensus support ACP as essential in cancer care 1
• Identifying and engaging a surrogate in the process of ACP is especially important because delirium and other forms of cognitive impairment are prevalent during treatment and as malignancies advance 1

Sentinel Events in Cancer Care

• Certain sentinel events in the disease process should trigger goal-oriented discussions, as patients' preferences may change as circumstances evolve 1
• Minimal standards for when ACP should be discussed include at diagnosis of cancer, before an expected death from cancer, and at other sentinel events 1
• Patient concerns are in flux over the course of illness, making it important to readdress them periodically 1

Supportive Care Integration

• Domains of information and care planning important for high-quality cancer care include integration of palliation into cancer care, advance care planning, and continuity of care planning 1
• Palliative care should be integrated into comprehensive cancer care, with skilled specialists and interdisciplinary teams available to provide consultative or direct care 2
• Patients and families should be informed that palliative care is an integral part of their comprehensive cancer care 2

Technological Advances in Cancer Detection

• Early detection of cancer or precancerous changes allows early intervention to slow or prevent cancer development and lethality 5
• Medical imaging is crucial for identifying various cancers, though manual interpretation can be subjective and time-consuming 6
• Advances in technology and biological understanding highlight the importance of accelerating early detection research to transform cancer survival 5

Patient Information Needs

• Cancer patients' information needs may differ at various stages of the cancer journey, though most continue to have significant information needs even after treatment completion 7
• Educational attainment, age, treatment status, gender, and ethnicity are all significant predictors of information needs in various domains 7
• Physicians should regularly ask patients what information they would like to know, who else should be given the information and involved in decision making, and how that information should be presented 4