The United Kingdom Cancer Treatment: Individualized Treatment Plan - Essay Example

Individualising cancer patients' treatment plan Introduction The ultimate goal for oncologists is to individualise each patient's treatment plan. How realistic this goal is remains to be determined. Currently in the UK, many cancer treatment plans have not been individualised. This paper investigates the approach of cancer treatment in the UK and the need of individualising each patient's plan. The UK cancer treatment In the UK, many cancer patients undergo a 'trial and error' treatment and dosage adjustment approach. This is very dangerous since some drugs can be fatal to patients who have particular genotypes. Another great challenge is that many regimens have numerous drugs with whose toxicities overlap, such as inducing myelosuppression. Should excess myelosuppression be observed in a cancer patient under multiple therapies, it is very hard to identify the specific drug causing the condition. To resolve such issues and allow for individualisation of cancer treatment, it is important that the patient be tested for his or her TPMT genotype. TPMT status testing has also been included into therapeutic procedures at St Jude Children's research Hospital from 1991.1 Some genotype therapy combinations are capable of affecting the late effects of cancer treatments for lymphoblastic leukaemia which is capable of causing second tumours. Defective TPMT activities and prior mercaptopurine treatment have been known to lead to irradiation-linked brain tumour and etoposide-related severe myeloid leukemias. This calls for a confluence of genetic features and treatment interaction to help in creating danger groups. Evidence from reliable sources has shown that increased TGN leverage can boost carcinogenesis. Although is possible to make out patient subgroups capable of tolerating drugs that would otherwise be dangerous for others, it is vital to bear in mind both the long term and short term effects of this medicine. In the UK, 5-FU is commonly prescribed for cases of solid tumours like colorectal and breast cancer. It has bee observed that over 80 per cent of 5-FU is deactivated by DPD, which varies from 8 to 21 times among patients. Patients showing signs of low DPD action may not effectively deactivate 5-FU, which could lead to gastrointestinal, neurological and haematopoietic toxicity, which could turn out to be fatal. Even though it is not clear on the number of patients who have mutations reducing DPD function, acute toxicity happens after 5-FU treatment in patients who have low DPD activity. An estimated 3 per cent of the UK population is believed to be a carrier of a heterozygous mutation which inactivates DPD, while a negligible number are homozygous for deactivating any mutation. Nature of cancer treatment A number of cancer therapeutics destroy tumour cells, but a majority of them cannot differentiate these cells from the host cells, thereby destroying both the cancerous and non-cancerous cells. Drugs such as these have a very narrow therapeutic range because they have a relatively small ratio of the drug associated with anti-humour efficacy to that associated with toxicity. 2 For instance, even though anticyclones effectively treat breast cancer, its therapy is restricted to a particular cumulative dose due to the cardio-toxic effects of the drugs' high doses. If patients with genetic factors closely related to lesser likelihood of anthracycline-induced cardiac toxicity, then it will be easier to give higher, more efficient doses to these patients, therefore increasing the therapeutic range for this category of patient population. A number of tumours undergo mutations, or acquire somatic mutations, making them resist drug therapy, with some tumours not expressing the target where the treatment should be directed. Other cancer therapies are simply not effective due to host genetic polymorphisms in the genes encoding enzymes, thus limiting the exposure of cancerous cells to drugs. Response to tumour treatment is still commonly assessed by measuring of the tumour size through imaging. However, it can take a very long time for tumour size reductions to be visible and in some cases, it may never happen at all even if the patient is responding positively to treatment. The need for early evidence of response has sparked a lot of interest in the use of non-invasive techniques to image tissue functions. These techniques can be used to clinically try new drugs with the aim of giving an early indication the drug's efficacy and eventually in the clinic to choose the best therapy at early stages of medication. 3 The need to individualise cancer treatment in the UK Oncologists in the UK should individualize each patient's treatment plan since these patients differ from each other and so is the nature of tumours. Moreover, patients may have different goals for their treatment plans. Some may take the plan in order to be cured while others may take it to control the cancer and make it manageable. Further still, there are some patients whose situation may be too advanced to be cured or has failed to respond to treatment, and only take the plan for comfort and improve the quality of life. Patients opting for curative treatment are usually those whose tumours are not so developed and have chances of being surgically removed before they advance further. Patients with such a goal may not mind enduring some short term effects in exchange for a chance to be cured. Moreover, they may be willing to do whatever it takes to be cured and resume their normal life. 4 There is another category of patients who may only be interested in controlling the tumour and maintain it at a manageable level. This is especially the case when the cancer is at a later stage, or if past treatment attempts have not been as successful as earlier anticipated. Such patients shift their goals from cure to control the cancer and accept the situation just as it is and hope for the best. These patients may opt for treatments aimed at temporarily shrinking or stopping growth of the cancer and not completely eradicating it. Such patients may not be willing to put up with any side effects brought about by the harsher treatment procedures. There is still another category of cancer patients whose cancer stage is very advanced or has not responded to any form of treatment. For such patients, the most important thing in their life is comfort, and may not be interested in treatment that denies them this comfort. The oncologist may need to work closely with such patients to ensure they do not experience pain and to minimise other symptoms of the cancer. Oncologists need to individualise each patient's treatment plan in order to make reasonable treatment decisions, bearing in mind the patient's type of cancer, its stage, and all the treatment options available and the probability of these treatments working under the given circumstances. The oncologist should discuss with each patient individually about the nature of their cancer. They could use patient education materials and websites to supplement their knowledge about the various types of tumours. 5 After establishing the exact nature of the tumours, the oncologist should start treating the patient with primary therapy. Primary therapy may involve surgery, radiation, chemotherapy or a combination of all these. Cancer treatments can sometimes be used alongside each other, with the treatment used after the primary therapy being referred to as adjuvant therapy. For instance, the oncologist can combine radiation or surgery with chemotherapy and a number of other treatment options.6 There is need for oncologists to individualise each patient's treatment plans after analysing the benefits and risks involved for every case, then deciding which treatments are appropriate for the particular patient. Treatments being considered should be rated basing on their merits and demerits. The oncologist must consider the side effects, the effect of the treatment on the patient's life, the financial cost of the treatment and the patient's health in general. Every treatment comes with its own array of side effects and therefore the oncologist and the patient should take time in reviewing them and deciding whether they are worth enduring or if they are overwhelmingly too much to bear. The oncologist should inform the patient about the various side effects for every treatment to enable the patient make informed decisions. The oncologist should also any options available to manage these side effects in order to make the treatment more bearable. The cancer patient may want to know how the treatment affects his or her life, especially how their roles in the family will change. They may also want to know if they might need to travel far away from home for this treatment and the impact of the treatment on their everyday life. For instance, if the treatment requires the patient to be a day or so off work, the patient may have to make prior arrangements to that effect. 7 Cancer patients may want to consider the overall cost of their treatment before deciding on the treatment plan to take. The oncologist should help the patient in investigating the type of treatment covered by the patient's insurance provider before making the decision. In case a particular treatment is not covered, the patient may want to consider whether or not they can afford an alternative funding for it. Another reason why treatment plans for cancer patients need to be individualised is because some patients may have other health conditions that could be affected by the treatment. For instance, corticosteroids, which are often used to treat people with cancer, could end up complicating the treatment of diabetes and also affect the chances of developing osteoporosis, hypertension and cataracts. Generally, the patient's personal goals and values will greatly influence the type of treatments suitable for them. Only the patients, with the guidance of the oncologist, can decide the kind of treatment that suits their life, depending on their circumstances. Moreover, they should not feel as though they should decide on a particular treatment plan and stick to it. They should leave open the possibility of changing their minds in future should the chosen treatment not achieve its intended goals and objectives. The oncologist and his or her patient should develop an effective communication between them to ensure the patient gets the information required to make informed decisions. To enhance this communication, the patient should always speak up whenever they do not understand, write their questions for the oncologist well in advance, have someone accompany them to the oncologist and keep copies of their medical records. The patient and the oncologist may require more than just one meeting and conversation to properly understand each other. 8 The question as to the best treatment for a cancer patient does not have a 100 per cent right or wrong answer since circumstances vary greatly. The patient may want to fully get involved with his or her treatment plan in order to have a peace of mind to enable him or her focus their energy on what needs to be done most, which is keeping themselves healthy all through their treatment. As cancer patients make their treatment decisions with their oncologists, they may want to take their time to make sure they have adequate information before the decision. Even though cancer diagnosis may make the patients feel like they must make urgent decisions and start the treatment, they may, in most cases, want to have time to make the decisions. This is in order to weigh all the aspects concerning the condition they are in and the consequences before making such an important decision. Cancer patients can always change their mind with regard to the treatment they decide to undertake. This can come as a result of the side effects of a particular treatment as well as other factors. Individualised treatment plan can greatly help the patient in making treatment decisions. Moreover, an individualised cancer treatment plan makes it easier for the patients to seek second opinions should need arise. Oncologists acknowledge the need for a second opinion especially when faced with the task of making an important decision. An individual treatment plan will enable those giving the second opinion know the specifics about the patient's condition much easily. 9 Some cancer patients decide not to have treatment at all, especially when the case is very advanced and impossible to treat. They instead choose to treat the pain and other effects of their cancer in order to make the best use of the time they are left with, although they can still change their minds. This does not mean that oncologists should leave such patients alone. They should develop individualised treatment plans to help these patients meet their goal of living a good quality life before the condition gets the better of them. Conclusion Cancer conditions are not all the same, and are instead very specific depending on various factors. Moreover, the circumstances of the patient play a pivotal role when deciding the type of treatment to undergo. These circumstances are also very specific to a particular patient; no patient can have exactly similar circumstances as the other patient. Also, patients have varying treatment options available to them, with some having more than others. Cancer patients may also have other medical conditions at the same time, thus requiring one to be very careful with the type of treatment to be taken. For instance, conditions such as diabetes do not respond to some drugs used for treating cancer. In addition, the stage of the cancer may warrant a more individualised type of treatment plan since some stages need more attention than others. Some conditions, especially the advanced ones only require pain treatment to make the patient more comfortable and make better use of the time left. Furthermore, the financial cost involved in the treatment is a very important factor that needs consideration before deciding on the treatment plan to be taken. The patient must choose a plan that he or she can comfortably afford, putting into consideration the insurance coverage. From all these factors, it is clear that oncologists should make it their goal to individualise each patient's treatment plan. Even though this comes with its own set of challenges, it is the most realistic approach to proper cancer treatment and management. 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