Palliative care is also an important approach to the treatment of gastric cancer. What factors will physicians consider when developing a palliative care plan? What principles will be followed? This article will provide an overview of this.
What factors are considered?
What factors are considered?
What factors are considered?
- Pathologic staging includes the depth of tumor infiltration, relationship to surrounding tissues, lymph node metastasis, and distant metastasis. The focus of treatment differs with different staging. Early palliative treatment is mainly aimed at potentially resectable gastric cancer, with systemic treatment as the main focus and symptomatic treatment as a supplement, with the hope of increasing the chances of tumor conversion to resectable through treatment. Late stage palliative care is mainly for gastric cancer that cannot be resected radically, and is mainly based on symptomatic treatment, supplemented by systemic treatment, with the main purpose of improving the quality of life and prolonging survival. For patients with end-stage gastric cancer whose survival is only a few days to a few weeks, humanistic care is mainly provided.
- Patients in good health patients in good health with a physical status ECOG score no greater than 2 can usually tolerate systemic therapy, including radiotherapy, chemotherapy, and radiotherapy. Patients who are in poor health and have an ECOG score of no less than 3 may be considered by their physician for treatment reduction, local therapy, and systemic best support therapy.
- Symptoms For obstruction, physicians may consider palliative surgery or palliative radiation therapy. For patients with bleeding, surgery, endoscopy, or chemotherapy (often with a single oral agent) may be used as treatment options. Patients with nausea or vomiting may undergo surgery to relieve the obstruction or use antiemetics. For pain, physicians usually give pain medications.
- Tumor condition The degree of malignancy will vary depending on the location, growth pattern, and histologic staging of the tumor, and treatment options will vary as well.
- Tumor response to treatment, gene expression are also factors to consider when choosing a treatment regimen. For example, trastuzumab (Trastuzumab, trade name Herceptin) may be added for patients who are positive for HER2 (human epidermal growth factor receptor 2), and mutations in genes such as NRAS and BRAF may render some targeted drugs ineffective, and doctors may adjust treatment regimens.
- Patients’ gender, age, and other characteristics female patients with ovarian implantation metastases have different treatment options, and generally require palliative tumor reduction surgery if symptoms such as compression are present; younger patients are usually better tolerated and can be considered for intravenous chemotherapy and three-drug combination chemotherapy; older patients are usually less well tolerated Older patients are usually less tolerant and are usually treated with single-agent oral therapy. Economic factors, patient compliance, etc. are all factors that physicians will consider.
- Pathologic staging includes the depth of tumor infiltration, relationship to surrounding tissues, lymph node metastasis, and distant metastasis. The focus of treatment differs with different staging. Early palliative treatment is mainly aimed at potentially resectable gastric cancer, with systemic treatment as the main focus and symptomatic treatment as a supplement, with the hope of increasing the chances of tumor conversion to resectable through treatment. Late stage palliative care is mainly for gastric cancer that cannot be resected radically, and is mainly based on symptomatic treatment, supplemented by systemic treatment, with the main purpose of improving the quality of life and prolonging survival. For patients with end-stage gastric cancer whose survival is only a few days to a few weeks, humanistic care is mainly provided.
- Patients in good health patients in good health with a physical status ECOG score no greater than 2 can usually tolerate systemic therapy, including radiotherapy, chemotherapy, and radiotherapy. Patients who are in poor health and have an ECOG score of no less than 3 may be considered by their physician for treatment reduction, local therapy, and systemic best support therapy.
- Symptoms For obstruction, physicians may consider palliative surgery or palliative radiation therapy. For patients with bleeding, surgery, endoscopy, or chemotherapy (often with a single oral agent) may be used as treatment options. Patients with nausea or vomiting may undergo surgery to relieve the obstruction or use antiemetics. For pain, physicians usually give pain medications.
- Tumor condition The degree of malignancy will vary depending on the location, growth pattern, and histologic staging of the tumor, and treatment options will vary as well.
- Tumor response to treatment, gene expression are also factors to consider when choosing a treatment regimen. For example, trastuzumab (Trastuzumab, trade name Herceptin) may be added for patients who are positive for HER2 (human epidermal growth factor receptor 2), and mutations in genes such as NRAS and BRAF may render some targeted drugs ineffective, and doctors may adjust treatment regimens.
- Patients’ gender, age, and other characteristics female patients with ovarian implantation metastases have different treatment options, and generally require palliative tumor reduction surgery if symptoms such as compression are present; younger patients are usually better tolerated and can be considered for intravenous chemotherapy and three-drug combination chemotherapy; older patients are usually less well tolerated Older patients are usually less tolerant and are usually treated with single-agent oral therapy. Economic factors, patient compliance, etc. are all factors that physicians will consider.
What principles are followed?
What are the principles?
- Strictly grasp the indications for palliative care, “never palliate what can be cured”.
- For pain, a “three-step approach” of non-opioid, weak opioid, and strong opioid analgesics is followed, based on an assessment of pain level.
- Restore as much autonomy to the patient’s life as possible.
- Improve quality of life and positively influence the disease progression process as much as possible.
- Palliative care should be used as early as possible in the early stages of disease treatment, in combination with radiotherapy and chemotherapy.
- Respect life and view death as a normal process: no meaningful delay in the dying process when all kinds of treatments are ineffective and futilely increase the patient’s suffering; aggressive treatment without delaying the disease when there is a glimmer of life.
- Provide a support system for the patient’s family to properly care for the patient.
Palliative care for tumors is a proactive, aggressive treatment, a comprehensive treatment aimed at improving the quality of patient survival and prolonging life as much as possible, and any palliative care program is developed in a comprehensive manner around this aim.