Quality of life apart from quantity of life As more and more cancers are getting cured, we need to look at the quality of life too. Curing cancer at any cost is not accepted casually in recent times. More than ever before, a premium is being placed on return to a productive and useful lifestyle after cancer treatment. The concept of organ and function preservation has been in the forefront of modern cancer care. The preservation of organ and function is now the standard of care in numerous malignancies including breast, larynx, rectum, anal canal, bladder, sarcomas of limb and many more, wherever possible. To be generally adopted, organ conservation approaches must have a likelihood of eradicating the tumour, have a low risk of recurrence and not compromise on organ form and function.
Let’s consider a few examples where organ preservation strategies have really made a difference in the patient’s quality of life:
* Throat cancers (larynx and pharynx): Traditionally, the treatment of laryngeal cancers involved total laryngectomy (removal of voice box) and radiotherapy either used alone or in combination. This radical surgery amounts to loss of speech, compromise in respiration and swallowing functions. The significant technological advancements in radiation delivery, availability of effective chemotherapy drugs, and voice rehabilitation have shifted the focus to ‘organ preservation’. The co-administration of chemotherapy and radiotherapy in properly selected patients has provided reasonable tumour control rates, organ preservation and maintenance of quality of life of the patients.
* Breast cancer: Mastectomy i.e. complete removal of breast and adjacent tissues has been the traditional standard surgery for patients diagnosed with breast cancer. This procedure not only leads to restriction of movements of the arm, but has a profound impact on the patient’s psyche. The loss of breast has a significant bearing on quality of life of breast cancer patients. With better understanding of tumour behaviour and technological advancements, mastectomy has been replaced by breast conservation surgery, where only the tumour bearing area and a rim of adjacent normal tissue is removed with acceptable cosmesis. This technique has shown equivalent tumour control rates and is now a widely accepted modality in the treatment of breast cancer.
* Bladder cancer: Cystectomy i.e. removal of the urinary bladder with an artificial passage of urine through the abdominal wall is the standard treatment for muscle-invading bladder cancers. The advancements in radiation planning and delivery techniques, availability of effective and less toxic chemotherapy drugs, have led to the development of bladder preserving approaches in carefully selected patients.
* Rectal cancer: Strong considerations are given to the functional outcomes while deciding the treatment protocol for rectal cancers. The restoration of bowel functions and anal continence are the issues on which importance is placed. In recent times, the use of pre-operative chemo-radiation protocols have led to the down staging of tumour, improved resectability and preservation of anal sphincter, and this has had a significant impact on a patient’s quality of life.
*Anal cancer: The traditional approach in the management of anal cancers involved loss of anal sphincter and permanent bag on abdominal wall for passage of stools. In the last three decades, chemo radiation has become the standard of care with preservation of anal sphincter and obviating the need of permanent stoma.
* Soft tissue/bone sarcoma of limbs: The traditional approach of amputation in these cancers dealt a significant blow to the patient’s quality of life. With the advancement and refinement of surgical techniques, rehabilitation services and effective chemotherapy drugs, limb preservation protocols are commonly practised. Multi-disciplinary collaborative approaches with knowledge and respect for the benefits and shortcomings of individual treatment modalities have led to the development of organ and function preservation protocols. Further efforts are being made in the endeavour to improve quality of life of cancer patients and provide acceptable cure rates.
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