Quality of Life

Quality of Life

Dramatic improvements in the management of side effects – including pain, nausea, and infection – have radically improved the quality of life for patients undergoing cancer treatment.

Major advances include the development of potent anti-nausea drugs, which enable most cancer patients to receive chemotherapy in an outpatient setting with minimal disruption to their daily routines. Pain management has also improved, along with recognition and treatment of emotional distress related to a patient's cancer diagnosis. Addressing quality of life issues is now considered an integral part of quality cancer care, as are support services for patients and families.

With record numbers of cancer survivors, programs have likewise been designed to ensure that medical monitoring and guidance needed to remain healthy are provided after treatment ends.

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1999

Chemoradiation shown conclusively to benefit patients with advanced disease

Chemoradiation shown conclusively to benefit patients with advanced disease

A major clinical trial confirms the value of giving carboplatin chemotherapy and standard radiation therapy together to patients with advanced oropharynx cancer. While the approach, called concurrent chemotherapy, causes more side effects than radiation treatment alone, patients receiving the concurrent therapy lived almost twice as long as the patients receiving radiation alone.

1998

New chemotherapy regimen reduces side effects for children with Hodgkin lymphoma

New chemotherapy regimen reduces side effects for children with Hodgkin lymphoma

Badge indicating that research was paid for using federal funds

A National Cancer Institute-funded study shows that a chemotherapy combination regimen known as ABVD (with the drugs doxorubicin, bleomycin, vinblastine and dacarbazine) can safely replace the previous standard treatment for patients with advanced Hodgkin lymphoma. This new combination dramatically lessens the side effects of cancer therapy for children with the disease, without affecting overall treatment outcomes.

1996

Sentinel lymph node biopsy introduced to assess breast cancer spread

Sentinel lymph node biopsy introduced to assess breast cancer spread

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An important study establishes a technique called sentinel lymph node biopsy as a standard part of breast cancer surgery. The procedure involves removing the lymph node closest to the primary tumor – the "sentinel" node – and examining it under a microscope for evidence of cancer. If the sentinel node is cancer-free, no further lymph nodes are removed and the patient is spared the previous practice of removing a large number of nodes and possibly larger sections of the breast. This more conservative approach allows for easier recovery and reduces the risk of postoperative side effects such as lymphedema, a painful swelling of the arm. If cancer is found, additional nearby lymph nodes are assessed, and often removed, and the patient is treated with additional chemotherapy after surgery. Recently, studies have shown that for some women, removing just the sentinel node may be sufficient.

1994

Watchful waiting introduced for men with early prostate cancer

Watchful waiting introduced for men with early prostate cancer

Prostate cancer often grows very slowly, and many tumors that are discovered in an early stage will never grow to the point of being life-threatening. To help avoid unnecessary treatments, doctors begin to practice watchful waiting (also called active surveillance), in which treatment is delayed or replaced by frequent exams and PSA testing for men with early-stage disease. This approach helps them identify patients whose cancer is more aggressive and requires treatment, while sparing others from the complications of unnecessary treatment.

Drug approved to help with saliva production

Drug approved to help with saliva production

Patients with head and neck cancers frequently experience chronic dry mouth, due to the effects of radiation therapy on the salivary glands. In 1994, the drug pilocarpine (Salagen), which can increase saliva production, is approved by the FDA for patients with head and neck cancer.

1993

Major study tracks long-term health of childhood cancer survivors

Major study tracks long-term health of childhood cancer survivors

As more and more children are cured of their cancer, researchers realize the need to better understand the long-term health effects of their cancer – and cancer treatment – as they age. In 1998, researchers from centers across the United States and Canada launch the Childhood Cancer Survivor Study, the first major study to monitor the long-term health of childhood cancer survivors. Over the coming years, their research sheds light on major long-term risks for these survivors, from increased risk of heart disease and stroke to secondary cancers later in life. These results enable physicians to monitor for these effects and provide more timely care.

1992

Sentinel lymph node biopsy introduced to assess the spread of melanoma to nearby lymph nodes

Sentinel lymph node biopsy introduced to assess the spread of melanoma to nearby lymph nodes

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A surgical technique called sentinel lymph node biopsy becomes a less invasive way to assess whether early-stage melanoma has spread to surrounding lymph nodes. The procedure involves surgically removing the lymph node(s) that receives lymph drainage from the primary tumor – the "sentinel" node – and then examining it under a microscope for evidence of cancer. If the sentinel node is cancer-free, no further lymph nodes are removed and the patient is spared the previous practice of removing multiple lymph nodes. This more conservative approach is easier on patients and reduces the risk of post-operative side effects such as lymphedema. Later studies show that results of sentinel lymph node biopsy are one of the most important predictors of risk for melanoma recurrence. This information helps doctors determine which patients should be treated more aggressively to prevent their cancer from returning.

1991

Powerful anti-nausea drugs alleviate major side effect of cancer treatment

Powerful anti-nausea drugs alleviate major side effect of cancer treatment

Ondansetron (Zofran) is approved by the FDA to prevent vomiting caused by chemotherapy and/or radiation. The drug works by deactivating the nervous system's natural trigger for vomiting. Other, similar drugs are soon approved, including granisetron (Kytril), dolasetron (Anzemet) and palonosetron (Aloxi). These and other anti-nausea drugs, like aprepitant (Emend), make it possible for most cancer patients to receive chemotherapy in an outpatient setting, with minimal disruption to their daily routines.

Better organ preservation with initial chemotherapy and radiation

Better organ preservation with initial chemotherapy and radiation

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A Phase III randomized trial shows that induction therapy, involving initial treatment with chemotherapy followed by radiation, is as effective as standard treatment but allows many patients with advanced laryngeal cancer to avoid surgical removal of their larynx and vocal cords. Until this time, such surgery, followed by radiation, was the only proven treatment for these patients.

This regimen – called induction therapy – remains the standard for more than a decade, until researchers discover that giving radiation and chemotherapy at the same time is more effective.

1990

Laparoscopic surgery minimizes pain, recovery time for several cancers

Laparoscopic surgery minimizes pain, recovery time for several cancers

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Beginning in the 1990s, laparoscopic surgery – in which a surgeon makes several small incisions and uses telescoping equipment to remove tumors – emerges as an alternative to traditional open surgery for some cancers, including kidney, prostate and colorectal cancer. This new approach allows patients to recover faster and experience less pain, without sacrificing effectiveness.

New surgical technique allows most men to maintain their sexual function, fertility

New surgical technique allows most men to maintain their sexual function, fertility

After identifying the lymph nodes where testicular cancer is most likely to spread, surgeons begin using a new surgical technique – called nerve-sparing or modified retroperitoneal lymph node dissection – to remove the cancerous testicle and the affected nodes. Whereas previous surgical techniques generally left men unable to ejaculate following surgery, this new approach spares key nerves and tissue. Over time, refinements to the approach enable 95 percent of men with testicular cancer to maintain their sexual function and fertility.

1989

Drugs to boost blood cells help patients finish cancer treatment, reduce infections

Drugs to boost blood cells help patients finish cancer treatment, reduce infections

The FDA approves the drug epoetin alpha (Procrit, Epogen) to stimulate production of red blood cells in patients with severe anemia, one of the most common and serious side effects of chemotherapy. These drugs are soon joined by white blood cell-boosting drugs such as filgrastim (Neupogen) and pegfilgrastim (Neulasta). The new treatments help reduce the need for blood transfusions and make chemotherapy safer by reducing the risk of infections and related hospitalizations.

1987

Some testicular cancer patients can forego chemotherapy

Some testicular cancer patients can forego chemotherapy

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Studies show that many men with early-stage testicular cancer can forego chemotherapy after surgery, and instead receive "active surveillance" (regular check-ups to monitor for cancer recurrence). When cancer does recur, available drugs are generally able to cure the disease. This approach spares many men from the side effects of possibly unnecessary chemotherapy, and is now the standard approach for about 75 to 80 percent of patients.

New surgical technique helps more men with bladder cancer maintain sexual function

New surgical technique helps more men with bladder cancer maintain sexual function

Previously, nearly all men who underwent surgery to remove their bladder also lost sexual function. But in the late 1980s, researchers map out the nerves surrounding the bladder and prostate and develop a new surgical technique that spares key nerves involved in male sexual function. As this approach is refined, as many as 80 percent of properly selected young men who undergo bladder cancer surgery are able to maintain their potency.

Researchers hone standard chemotherapy to increase effectiveness, minimize side effects

Researchers hone standard chemotherapy to increase effectiveness, minimize side effects

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A new standard of care is established when a trial shows that using the drug etoposide (Toposar, VePesid), instead of vinblastine (Velban, Velsar), together with cisplatin and bleomycin (Blenoxane) leaves more patients cancer-free and causes far fewer nerve and muscular side effects. Over time, researchers also learn that many men respond well to three cycles of chemotherapy, rather than four, and that patients who do relapse can generally be cured with one additional round of chemotherapy.

1986

Global guidelines help ensure proper pain management

Global guidelines help ensure proper pain management

Pain is common among patients with advanced cancer but hasn't always been well-managed. In 1986, the World Health Organization issues clear guidance on the use of pain medications for cancer patients, focusing on stronger, opioid-type drugs such as morphine. The guidelines address widespread concerns about addiction, tolerance and abuse, which made some providers reluctant to prescribe the drugs. Adherence to the guidelines has been found to provide reliable pain relief for up to 90 percent of patients. In later years, other organizations, including ASCO, propose guidelines to help doctors recognize and talk to their patients about pain and its management.

1985

Minimally invasive approach useful for some rectal cancers

1984

Less extensive surgery found effective for removing melanoma tumors

Less extensive surgery found effective for removing melanoma tumors

Instead of the traditional practice of surgically removing up to two inches of skin and tissue surrounding a melanoma tumor, clinical trials show that margins of three-quarters of an inch or less around the tumor are sufficient. This refinement makes recovery easier and helps reduce the cosmetic impact of surgery.

1982

New surgical approach helps preserve sexual and urinary function
Limited surgery helps rectal cancer patients avoid colostomies

Limited surgery helps rectal cancer patients avoid colostomies

A new procedure called total mesorectal excision emerges as a new standard surgical treatment for many patients with rectal cancer. The procedure involves removing only the cancerous region of the rectum, allowing patients to maintain normal bowel function. Previously, nearly all patients with rectal cancer had to undergo permanent colostomies (elimination of waste through an opening in the abdomen connected to a colostomy bag).

1978

Modification of standard surgical technique leads to fewer complications for patients with early-stage pancreatic cancer

Modification of standard surgical technique leads to fewer complications for patients with early-stage pancreatic cancer

Surgeons refine the standard surgical approach for removing pancreatic tumors, called the "Whipple" procedure. The modified pylorus (stomach)-preserving approach takes less time to perform, requires a shorter hospital stay, and results in similar survival outcomes. Patients treated with this new approach also have a lower risk of long-term side effects, which can include gastrointestinal distress, ulcers, cramping and dizziness.

1977

Removing just part of the cancerous kidney is proven safe and effective

Removing just part of the cancerous kidney is proven safe and effective

Studies indicate that some patients with early-stage malignant tumors in one or both kidneys are candidates for partial nephrectomy – surgery in which the tumor and only part of the kidney is removed, as opposed to removing the whole kidney. This refined approach revolutionizes treatment of such tumors, preserving patients' kidney function and helping many to avoid the difficult experience of long-term dialysis.

Many women can opt for breast-conserving surgery

Many women can opt for breast-conserving surgery

Studies show that a procedure called lumpectomy – involving the removal of only the tumor, and not the entire breast – followed by radiation therapy is as effective as mastectomy for women with early-stage breast cancer. The finding helps dramatically reduce the physical and cosmetic side effects of breast cancer treatment and enables women to recover more quickly after surgery and return to their normal lives.

1974

Antibiotic bleomycin helps reduce treatment-related side effects

Antibiotic bleomycin helps reduce treatment-related side effects

Bleomycin (Blenoxane), an anticancer antibiotic, is approved by the FDA, and soon becomes part of standard treatment for testicular cancer. The new drug is found to be an ideal component of combination chemotherapy because, unlike other anticancer drugs, it does not suppress the bone marrow's ability to produce red and white blood cells. Patients who are able to maintain higher blood cell counts are far less likely to experience treatment-related complications.

1971

More limited mastectomy proven effective for early-stage breast cancer

More limited mastectomy proven effective for early-stage breast cancer

Badge indicating that research was paid for using federal funds

While radical surgery had been routinely used to treat breast cancer, a more limited surgical procedure called total mastectomy (removing just the breast tissue instead of removing the breast, chest wall muscle and underarm lymph nodes) is confirmed to be as effective for women with early-stage breast cancer. The procedure reduces pain after surgery and speeds recovery for patients. This advance paves the way for future breast-conserving surgeries.