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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2016

Olanzapine prevents chemotherapy-induced nausea and vomiting

Olanzapine prevents chemotherapy-induced nausea and vomiting

A large clinical trial finds that olanzapine (Zyprexa) prevents chemotherapy-induced nausea and vomiting more than standard anti-nausea treatments. In addition to being uncomfortable and debilitating, nausea and vomiting can prevent patients from completing their full course of chemotherapy, increasing the chance of recurrence, and shortening survival. These results add to previous research suggesting olanzapine’s benefit for patients receiving chemotherapy.

Olanzapine prevents chemotherapy-induced nausea and vomiting

Olanzapine prevents chemotherapy-induced nausea and vomiting

A large clinical trial finds that olanzapine (Zyprexa) prevents chemotherapy-induced nausea and vomiting more than standard anti-nausea treatments. In addition to being uncomfortable and debilitating, nausea and vomiting can prevent patients from completing their full course of chemotherapy, increasing the chance of recurrence, and shortening survival. These results add to previous research suggesting olanzapine’s benefit for patients receiving chemotherapy.

2014

Early palliative care shows continued benefits

Early palliative care shows continued benefits

Building on previous data from smaller studies, a large study shows that integrating palliative care into standard care for patients with advanced cancer can help improve patients’ quality of life and their satisfaction with care.

Conducted in a range of cancer care settings, this study offers insights into how a more collaborative care model might be broadly implemented.

2011

New tool helps physicians tailor chemotherapy treatment for older patients

New tool helps physicians tailor chemotherapy treatment for older patients

Researchers develop a new assessment tool that helps physicians identify older adults with cancer who will have difficulty tolerating and completing chemotherapy. The tool considers factors such as other illnesses, mental function, social support, and nutritional status to predict an elderly patient's risk of side effects. The model will help physicians tailor cancer treatment in a way that maximizes quality of life for the patients.

2010

Adding palliative care to standard chemotherapy improves survival for advanced lung cancer patients

Adding palliative care to standard chemotherapy improves survival for advanced lung cancer patients

A head-to-head trial shows that patients who received standard chemotherapy along with palliative care (specialized treatment to address the symptoms of cancer, but not treat the disease) immediately after their diagnosis with advanced lung cancer lived three months longer and had a higher quality of life than patients who had chemotherapy alone. Patients who received the combination approach were also less likely to undergo aggressive therapy at the end of life, such as resuscitation. The results demonstrate the potential for palliative care to no only improve quality of life, but to extend patients' lives as well.

Removing fewer lymph nodes for some breast cancer patients does not impair survival

Removing fewer lymph nodes for some breast cancer patients does not impair survival

Two large clinical trials confirm that less extensive lymph node surgery in women with early-stage disease does not reduce their likelihood of survival. Specifically, researchers find that removing additional underarm lymph nodes to look for breast cancer in women with limited or no disease spread in the "sentinel" node – where cancer is most likely to spread – does not make a significant difference in survival, compared to removing fewer nodes. Removing fewer nodes decreases the risk of side effects, such as pain and swelling in the affected arm.

2008

Minimally invasive surgery shown to be effective for cervical cancer

Minimally invasive surgery shown to be effective for cervical cancer

In a small study, researchers find that two minimally invasive techniques – laparoscopic and robotic radical hysterectomy (removal of the uterus) with radical pelvic lymphadenectomy (removal of surrounding pelvic lymph nodes) – are as effective as traditional radical hysterectomy and lymphadenectomy in women with cervical cancer. The procedures, which are performed through small incisions, are associated with less blood loss and shorter hospital stays than traditional, open surgery. While both of the new techniques had already been put into limited practice, this study provided evidence to support their widespread use.

2007

Psychosocial support becomes an integral part of cancer care

Psychosocial support becomes an integral part of cancer care

A growing body of research highlights the importance of providing "psychosocial" services to help patients address depression, anxiety and other emotional challenges after a cancer diagnosis. In 2007, the Institute of Medicine issues a report recommending that all cancer care providers make psychosocial services an integral part of patients' care, to improve their quality of life and help them adhere to their cancer treatment. Since then, ASCO and other medical and patient groups have developed additional guidance and information to help ensure that patients and their families receive the support they need to maintain their well-being.

Shorter course of radiation therapy is as effective as less frequent radiation therapy for early-stage breast cancer

Shorter course of radiation therapy is as effective as less frequent radiation therapy for early-stage breast cancer

Findings from the START Trial suggest that "hypofractionated" radiation therapy, which involves fewer but larger doses of radiation delivered over a shorter period of time, is as effective as conventional radiation for reducing the risk of cancer recurrence among women with early-stage breast cancer, and does not cause greater damage to healthy breast tissue. Since traditional radiation therapy for breast cancer can take five to six weeks to complete, this shorter course (as little as three weeks) is a more convenient option for some patients and makes it easier to complete all cycles of treatment.

Diet, exercise reduce risk of colon cancer recurrence

Diet, exercise reduce risk of colon cancer recurrence

Patients who follow a low-fat diet and exercise regularly are found to have a lower risk of colon cancer recurrence after surgery for early-stage disease, demonstrating that lifestyle factors can have a significant impact on cancer recurrence. The results provide patients with new tools for reducing the risk that their cancer will return.

2006

Many breast cancer survivors experience fatigue

Many breast cancer survivors experience fatigue

A large study shows more than one-third of long-term breast cancer survivors report elevated fatigue 5 to 10 years after their cancer diagnosis. Women in the study had completed all cancer therapies other than tamoxifen (Novaldex). The findings suggest that persistent fatigue may be common among breast cancer survivors, and heightens awareness of this symptom among healthcare providers and caregivers.

Treatment with new targeted drug cetuximab prolongs life

Treatment with new targeted drug cetuximab prolongs life

Important data emerge on the value of the targeted drug cetuximab (Erbitux), showing this therapy extends survival and improves quality of life for patients with head and neck cancers.

One large trial shows that adding cetuximab to standard radiation therapy significantly extends the lives of patients with head and neck cancer that has not spread beyond this region of the body. Notably, the addition of cetuximab does not carry significant added side effects. Soon after, the FDA approves cetuximab for this use and in patients with advanced disease who have not responded to previous chemotherapy. Since the value of cetuximab has not yet been confirmed by additional positive trials, however, many researchers remain cautious about the drug's benefits.

2005

Drug approved to reduce oral sores caused by cancer treatment
Research sheds light on long-term health problems of cancer survivors

Research sheds light on long-term health problems of cancer survivors

In the 1990s, researchers begin a major study of the long-term effects of cancer and its treatment, focusing on survivors of childhood cancer. In 2005, the Childhood Cancer Survivors Study reports that survivors' risk of long-term health problems – including heart problems, second cancers and scarring of the lungs – was five times greater than that of their healthy siblings. Similar results have been found for survivors of other cancers with high cure rates, such as testicular cancer.

The results are helping oncologists and primary care providers monitor and better manage the long-term health of the millions of cancer survivors alive today.

Testicular cancer survivors face increased risk of second cancers, other health problems

Testicular cancer survivors face increased risk of second cancers, other health problems

A major study finds that survivors of testicular cancer – especially those who received radiation or chemotherapy – have double the risk of developing a second cancer three or more decades after their initial diagnosis. Other research identifies an increased risk of cardiovascular disease and chronically low testosterone. These findings highlight the need for doctors to continually monitor for long-term health effects among the growing number of cancer survivors.

Low-fat diet and regular exercise may reduce risk of breast cancer recurrence

Low-fat diet and regular exercise may reduce risk of breast cancer recurrence

Two large clinical trials suggest that lifestyle changes, including a low-fat diet and exercise, decrease the risk of breast cancer recurrence and death in women with early-stage breast cancer. The findings are among the first to demonstrate that healthy lifestyle changes can have a substantial impact on breast cancer outcomes.

2004

Laparoscopic colon cancer surgery effective, better tolerated

Laparoscopic colon cancer surgery effective, better tolerated

A study by researchers at multiple cancer centers finds that laparoscopic surgery to remove colon tumors was as effective as conventional open abdominal surgery, and was associated with shorter hospital stays and less pain after surgery. Laparoscopic surgery involves removing the tumor through multiple small incisions and a telescoping camera device. This less-invasive approach is now widely used.

Chemotherapy and radiation before surgery reduce side effects for rectal cancer patients

Chemotherapy and radiation before surgery reduce side effects for rectal cancer patients

Results from a large clinical study show that giving chemotherapy and radiation therapy before, rather than after, rectal cancer surgery reduces the risk of local recurrence (cancer recurrence in the pelvis, near the original tumor). Survival was similar in both approaches, but because the pre-surgery treatment regimen was more tolerable, it is now the standard approach for treatment of rectal cancer.

2003

First oral chemotherapy drug helps simplify colon cancer treatment

First oral chemotherapy drug helps simplify colon cancer treatment

The FDA approves capecitabine (Xeloda) for patients with advanced (metastatic) colon cancer, and later for patients with stage III colon cancer (cancer with limited spread in the surrounding tissue) who have had surgery to remove the tumor. Capecitabine is a pill version of the widely used intravenous chemotherapy drug 5-fluorouracil that offers comparable effectiveness with a more convenient way for patients to receive their treatment. Recently, capecitabine has been combined with the drug oxaliplatin (Eloxatin) as an initial therapy for metastatic colon cancer and for early-stage colon cancer.

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

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

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

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.

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.

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

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

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

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

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

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

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.