Sometimes there is suddenly a chance for recovery

Sick at the end? New treatments offer some groups of patients with metastatic cancer the prospect of a cure. This raises new doubts – for patients and doctors.

It was simple for us healthcare providers, says Eric Geitmann, MD, an internal medicine physician and oncologist at the Erasmus MC Center in Rotterdam. Geijteman conducts research on end-of-life care. “If someone with metastatic cancer deteriorated, we knew the patient would die in the foreseeable future. We could then organize care accordingly.”

New treatments

Nowadays, other promising cancer treatments such as immunotherapies and targeted therapies are also available for some patients. “So it's not for all patients,” Geigtmann emphasizes. “So far, chemotherapy can only be given to some forms of metastatic cancer, such as pancreatic cancer. For other forms of cancer, such as metastatic lung cancer, colon cancer, and melanoma – a specific skin cancer – these promising treatments can be used under certain circumstances.

Geteman and a number of his colleagues published an article in the scientific journal about the successes of these treatments British Medical Journal. Immunotherapy stimulates the body's immune system to eliminate the cancer cells themselves. With targeted therapy, medication does this job.

healing?

For example, immunotherapy can be so successful that it can be prescribed as a cure. Although it's still too early to conclude, Geitman says. “For example, there are no known long-term survival numbers.”

But the signs in certain groups of patients are very good. “About one hundred percent of all people with metastatic melanoma who respond successfully to immunotherapy will live well for at least five more years.” Previously, this group of people lived six to nine months at most. Unfortunately, immunotherapy is not successful in all patients with metastatic melanoma, but only in six out of ten patients. As of now, it is not known why this happens and who will or will not respond well.

Amazing and fast

Targeted therapy experiences are great too. And also because this treatment works very quickly. Geitman: “Patients with metastatic cancer are regularly admitted to the hospital, and we, as doctors, usually expect them to die soon. If the treatment is successful, we can get them back to good condition remarkably quickly.

The BMJ article describes a 58-year-old patient with advanced metastatic lung cancer. In her final stage, she needs artificial respiration in intensive care. Until she is given the medication through tube-guided therapy. She was then able to leave the ICU after seven days in good condition.

Judicial notice

Patients vary, Geitman stresses. “Targeted therapy can only be used in a limited group of all patients with metastatic cancer. For example, in twenty percent of lung cancer patients, they have a specific abnormality in the cancer cell. Of this group, 60 to 80 percent benefit.”

Another side note: The effect of this treatment is not permanent. “Sooner or later, resistance occurs, sometimes after a few months, sometimes after a year or several years. There is not much to say about this in advance,” says Geitman. The big advantage of targeted therapy is that the patient can recover very quickly, which in turn makes New treatment options are possible: immunotherapy, for example.

Targeting healthy cells

Unfortunately, these treatments also have side effects. The oncologist explains that immunotherapy can also target healthy cells. “Organs that have never had problems before, and that have never been diagnosed with cancer, can still be damaged.” For example, thyroid or joint problems can arise from immunotherapy.

The list of reported side effects of targeted therapy is long, such as diarrhea and fatigue, and in general, patients mainly experience only discomfort, Geitemann says. “But if you feel a lot of discomfort, that may also be a reason to stop treatment.”

Disturbing uncertainty

In general, these new treatments cause uncertainty for the patient. Geijteman compares this to a New Year's Eve lottery. “If I buy a ticket for this purpose, I do so with the idea: I will win the jackpot, otherwise I won't have to start.” He also sees a similar sentiment in people faced with the choice of whether or not to receive immunotherapy or targeted therapy. So there is great disappointment when treatment fails.

In general, it is about uncertainty. With immunotherapy, the question is: Will this treatment work? With targeted therapy: What is the duration of treatment? “This uncertainty can be so great that in extreme cases the patient is relieved when the treatment turns out not to work or does not work; then at least there is certainty about the future,” says the internal oncologist.

That's why Geitman advocates a two-track policy: the doctor must radiate the phrase “we're going for it” while also preparing the patient for setbacks. “If necessary, in several conversations.” According to him, supportive and palliative care has an important role to play in this. Geitman emphasizes that attention should be paid not only to physical problems, but also to the psychological, social and spiritual aspects of the disease and treatment.

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