The main goals of cancer diagnosis and treatment programmes are to cure or considerably prolong the life of patients and to ensure the best possible quality of life for cancer survivors. The most effective treatment programmes are those that:
- are provided in a equitable and sustainable way
- are linked to early detection and accurate diagnosis and staging
- adhere to evidence-based standards of care
Treatment programmes should also ensure timely and equitable access to effective therapy for cancer types that present with advanced disease but have high potential for being cured, such as metastatic testicular cancer (seminoma) and acute lymphatic leukaemia in children. Likewise, effective treatment exists for certain types of advanced cancer, where the goals of treatment are to prolong survival considerably and maintain good quality of life.
The first critical step in the management of cancer is to establish the diagnosis based on pathological examination. Obtaining a tumour sample is achieved through performing a biopsy or aspiration that may require an intervention such as an image-guided procedure or endoscopy. Pathology and laboratory medicine services are essential to accurately analyse and interpret patient samples, thereby guiding the diagnosis, treatment and management of the patient. It is then critical to determine the stage, that is, the degree of tumour spread from the primary site. Staging is used to help guide treatment options and estimate an individual’s prognosis.
Cancer treatment requires careful consideration of evidence-based options, which can include more than one of the major therapeutic modalities: surgery, radiotherapy and systemic therapy. The selection should be based on evidence of the best existing treatment given the resources available. Shared decision-making that takes into account patient factors including individual preferences is best. When possible, options to be presented to patients should be coordinated between providers in a multi-disciplinary manner to ensure timely and effective treatment. Combined modality therapy requires close collaboration among the entire cancer care team and should be delivered in an integrated, people-centred manner.
All types of cancer treatments can exert a significant psychosocial and financial impact on a patient and his or her family that should be considered when developing programmes to improve access to and coverage of cancer services.
The WHO list of essential medicines was updated in 2015 to include 30 cytotoxic and adjuvant medicines (anti-cancer medicines) that are part of proven clinically effective treatment regimens. This list has been vetted for efficacy, safety and quality, and comparative cost-effectiveness evaluations with other alternatives in the same class of medicines were performed to generate these important treatment tools. Cancer treatment services require a strong health system to ensure treatment is high-quality, effective, safe and accessible to all cancer patients.
After active treatment for cancer, a plan can be developed to monitor for cancer recurrence or spread, follow-up for and management of health problems related to cancer diagnosis or cancer treatment and assess for development of other types of cancer. These services include routine examinations and/or tests and are important to manage the consequences of cancer diagnosis and treatment.
SOURCE: World Health Organization (WHO).