cancer is generally seen as a sudden illness that changes the entire previous life of those affected and their environment, short-term and radical side-effects-laden treatments requires, may result in short-term unsuccessful treatment to death. This image is right and our determined efforts to caring for cancer patients in order to facilitate the handling of the disease. But this picture is not complete. It allows the increasingly large number of patients from outside, we must describe as chronic cancer patients. They can be divided into three groups: first
Patients with cancer who are not or only very slow progress
second Patients with advanced disease that must be treated again and again
third Patients after cancer
The first part presents the three groups in second part shows characteristics of emotional confrontation with a chronic disease, cancer, the third part, implications drawn.
The number of patients diagnosed with cancer increases'
Exact figures on the number of cancer there is in the Federal Republic, could not before. In the specialized clinics and medical practices, we see increasing numbers of patients.
first Patients with very slowly progressing cancer:
A group of very different types of cancer by a very slow, sometimes referred to for years and not progressive disease. Prime examples of this group are patients with chronic lymphocytic leukemia and low-grade non-Hodgkin's lymphoma. These diseases can be discovered by accident, for example, was carried out because of another reason, a blood test or because the operation of another disease, a lymph node was removed.
In some patients the disease is stationary over time, that it does not progress. For example, the average life expectancy of patients with germinal center lymphoma, the most common form of low-grade lymphoma, with over ten years. The disease in many patients must be treated only if it advances or the person concerned makes you sick - makes you sick in the sense of physical discomfort. Ill feel this Patients from the time of diagnosis.
prostate cancer can also, especially in old men, have a very slow pace. Both the low-grade lymphoma and prostate cancer among the cancer, the increase in frequency.
second Patients regularly in need of treatment of cancer:
The last years were marked in the treatment of cancer through the development and approval of many new drugs. This can now be treated diseases in advanced stages, for which no or few effective drugs were available. This is in part to substances in the field of chemotherapy, hormone therapy, but also to substances of the immunotherapy and novel agents such as drugs to prevent the formation of new blood vessels or to influence the bone metabolism. Particular progress has
it in patients with advanced disease of the colon. By chemotherapy, by treatment with a new anti-angiogenesis inhibitor, the average life expectancy of these patients by about five months in 1990 rose to over 20 months. Significant progress it is
including breast cancer, with prostate cancer, lung cancer, in gastric cancer with ovarian cancer, metastatic tumors of the bladder, in chronic leukemia and in the low-grade non-Hodgkin's lymphoma. The patients treated by these new treatments are not cured of their cancer, but they can live longer with less discomfort and with better quality of life.
third Patients after cancer:
increases the number of cured cancer patients, albeit slowly. The key is for most tumors in the early discovery. This is true for all organ tumors such as breast cancer, colon cancer, lung cancer, prostate cancer, etc.. In a group of patients with larger tumors and / or lymph node involvement can be a so-called adjuvant therapy, ie chemotherapy or hormone therapy after surgery and radiotherapy, the number of healed Patients increased.
Adjuvant therapy is standard for women with breast cancer in patients with colorectal cancer and more recently in patients with lung cancer. For each of these patients was shown that the forecast can be improved in high-risk situations by adjuvant treatment. There is also a small group of tumors, which is possible even with extensive metastatic disease a cure by chemotherapy.
These include germ cell tumors (testicular tumors), sarcomas, malignant lymphomas (Hodgkin's lymphoma and Non-Hodgkin's lymphoma) and acute leukemias. especially among children and adolescents, the cure rates are high, but also in adults can eg 90% of patients with testicular tumors and 50-80% of patients with high grade non-Hodgkin's lymphoma are cured. Have contributed to this improved cytotoxic agents, new drugs and high-dose therapy with stem cell transplantation.
patients with cancer forget 'the diagnosis never
first Burden of disease:
patients with chronic cancer must be based in their whole way of life from the disease. The following very schematic diagram of the emotional drain of dealing with acute and chronic disease is shown. After an initial phase of shock about the diagnosis (red) over weeks and months, a phase of the sovereign handling be achieved with the disease (orange and yellow). While the patient then the acute disease can reach the green area ', the chronically ill cancer expect relapses, worsening of the findings and new treatments. Cancer patients know that these phases do not expire so schematic as shown in the diagram. There are good and bad phases, emotional relapses and periods in which the disease is better to endure.
second Exposure to the disease:
An important finding of recent years is that even patients healed a long time, often for life, are burdened by the consequences of the disease and treatments. This relates to consequences of surgery, radiation and chemotherapy. On the loss of organs, such as gastrointestinal surgery or lung surgery, this is understandable to all. But less visible side effects, such as the force fatigue syndrome with generalized weakness and loss of efficiency, long-term burden on cancer patients and a change of lifestyle. The fear of a recurrence decreases with each month and year obtained, but remains present in most patients. Before the follow-up, they develop insomnia, become restless and are confronted with the fears as the initial diagnosis of cancer.
The doctor-patient relationship is changing
first Information:
patients with chronic Cancer must be based in their whole way of life from the disease. This first rise above all the need for information. Information about disease and treatment are almost fully available through the Internet. However, the abundance of unordered and unweighted information for many patients more confusing than enlightening. The following diagram - parallel to the emotional situation - the learning curve of patients is shown schematically. At the beginning of a disease's physical symptoms are often so dominant that a comprehensive recording of information is not or hardly possible. Over time, increases the need for information. Not a few chronically ill patients are about aspects of their disease better informed than the non-specialist physician. The role of support groups for teaching and assessment of information can not be overestimated in this situation.
second Shared decision making:
The doctor-patient relationship has changed dramatically in the last 20 years. This relationship is today, especially in the treatment of cancer patients, preferably by the model of 'Shared Decision Making', described in German participatory, that is joint decision-making. The model envisages that over with doctors and patients of their expertise in the treatment decisions Others bring.
Many treatments will not worsen the prognosis by a shift to days, weeks, sometimes months. In this case, the patient can decide when a treatment fit into his lifestyle.
medical decisions (such as the correct dosage) will largely lie with the doctor. Fundamental issues such as decisions to a specific treatment or for not carrying out a treatment require that doctors and patients to respect each and bring together the relevant expertise in the responsible decision. The doctor brings his expertise, the patient brings to a person with his history, his life plan and its already suffered competence 'through experience with the disease, a cancer.
Conclusion
Because of the success of early detection and treatment increases the number of people who are confronted in their lives diagnosed with cancer '. Many will be healed, others must and can live for years with cancer. These experiences shape with all stakeholders for the further life. In the training of physicians in the design of programs of self-help groups and health care we have to face the special requirements of chronic cancer patients.
Prof. Dr. B. Woermann, Medical Department, Division of Hematology / Oncology, Municipal Hospital Braunschweig
0 comments:
Post a Comment