The implementation of appropriate treatment in the course of receiving anti-cancer therapy, so that patients can maintain a relatively high quality of life while obtaining long-term disease control is the goal of oncologists’ efforts. In the face of the current situation, we have proposed the concept of oncology comfort medicine in our long-term oncology practice. The implementation of comfort medicine can significantly improve the quality of life and prolong the survival time for tumor patients.
I. What are the main contents of tumor treatment?
The treatment of tumor includes two main elements, one of which is indispensable. It is mainly through surgery, radiotherapy, chemotherapy, endocrine therapy and molecular targeted therapy to achieve the purpose of curing tumor or obtaining long-term survival; the second is supportive therapy, also called symptomatic therapy, which aims at relieving patients’ various symptoms and heart pain, making patients as comfortable as possible, helping patients to receive anti-tumor therapy smoothly and maintain a better quality of life.
In the process of tumor treatment, only by taking into account the above two aspects, can we obtain satisfactory results. Neglecting either aspect cannot be called a qualified treatment. In the past, the focus of both doctors and patients in cancer treatment was mainly on anti-tumor treatment, and not enough attention was paid to supportive treatment, and patients’ various symptoms and pains were not paid attention to and effectively treated, resulting in anti-tumor treatment leaving patients with mostly painful, unbearable and even unbearable memories.
A few patients also interrupted or refused further treatment due to unbearable side effects related to treatment, which affected the overall efficacy of tumor treatment. These painful experiences are witnessed by patients’ family and friends, and then become public impression and consensus, which invariably increase people’s fear and avoidance of cancer, and gradually form a vicious circle, which is very unfavorable to cancer patients’ cooperation with treatment.
The rapid development of modern medicine is not only reflected in many specific research results and treatment methods, but also in the respect and care for patients’ personality. Comfortable treatment of tumor is a vivid interpretation of this advanced medical humanistic concept, a sign of returning to rationality in cancer treatment, and a concrete embodiment of medical humanitarianism. We believe that through the joint efforts of both doctors and patients, the level of supportive treatment for cancer patients will be improved, human patients will enjoy the fruits of medical progress, and the painful memory of cancer and anti-cancer treatment will be gradually reversed.
What is comfort treatment for cancer?
Through the joint efforts of medical and nursing staff, family members, society, voluntary workers, clergy, etc., with the international standard of palliative care and disease classification guidelines as the standard, combined with the heterogeneity of regional culture, and the application of individualized and humanized integrated service model, cancer patients can receive reasonable, appropriate, moderate, acceptable and appropriate care to improve the quality of life, so that patients can enjoy the supreme life and comfortable life. The main purpose of comfort treatment is to relieve the cancer patient’s pain. The main purpose of comfort treatment is to relieve patients from various discomfort symptoms and to face the disease and life with a positive attitude. Comfort treatment should be started as soon as possible, and the earlier the patient receives comfort treatment, the more benefits the patient will have.
Comfort care includes optimal supportive care during curative oncology treatment and palliative care for patients with intermediate and advanced stages.
Patients with early stage tumors can achieve curative outcomes through a combination of treatments such as surgery and post-operative adjuvant therapy, and physicians often refer to this phase of supportive care as best supportive care. Its purpose is to help patients successfully receive anti-tumor treatment and eventually cure their cancer. The main contents of optimal supportive treatment include the control of tumor-related symptoms, the management of comorbidities of antitumor treatment, and the rehabilitation treatment after the end of overall treatment.
In western developed countries, the negative psychological impact of cancer diagnosis and treatment on patients is highly valued, and psychological counseling throughout the overall treatment process is also a part of the treatment. Thus, it can be seen that supportive treatment is not only limited to symptom control, but also includes psychological counseling and meeting spiritual needs of patients.
Intermediate-stage tumors account for the majority of cancer patients, and in addition to necessary surgery, they often need to receive radiotherapy to control cancer progression, extend life expectancy and achieve long-term survival. This stage is often long and can last for months or even years. Supportive treatment during this stage is called palliative care. Palliative care is the main treatment for patients with advanced tumors and always the only treatment for patients with terminal tumors. Its purpose is not only to improve symptoms, but also to prolong survival through palliative antitumor treatment, such as palliative radiotherapy or chemotherapy.
According to the information published by the World Health Organization in the 1990s, the main elements of palliative care include: pain and other symptom control is the primary task of palliative care; pay attention to the psychological and spiritual aspects of patients’ needs; and help patients face life with a positive attitude. Palliative care not only improves patients’ quality of life, but may also have a positive impact on the treatment of their disease, so it should be carried out as early as possible and combined with other treatments that prolong patients’ lives.
In 2010, oncologists at Massachusetts General Hospital published the results of a clinical study they conducted on lung cancer patients in which palliative care was formally shown to extend the survival of lung cancer patients. Their study randomized patients with advanced lung cancer into two groups, one receiving only antineoplastic therapy and the other receiving palliative care combined with antineoplastic therapy, and found that patients in the combined palliative care group lived longer. The results of this study have received widespread attention from oncologists around the world and have prompted doctors and patients to update the concept of oncology treatment and better integrate palliative care into the overall anti-tumor treatment so that more patients can benefit.
III. What are the main elements of comfort medicine
According to the development of the discipline, the basic components of comfort medicine in clinical symptom control currently cover at least eight different areas, including anxiety and depression, cognitive function, exercise, fatigue, immunity and infection, pain, sexual function and sleep disorders. Of these, the areas of anxiety and depression, fatigue, pain, and sleep disorders are well known to medical practitioners, but exercise, cognitive function, sexual function, immunity, and infection are less well covered. Exercise is important because of the observed evidence linking exercise after diagnosis to better outcomes.
In addition, interventional studies have shown that increased exercise after a cancer diagnosis among cancer survivors can lead to physical and physiological benefits. A significant proportion of cancer survivors are at risk for cognitive decline, and some studies have shown this to be associated with chemotherapy, with up to 78% of patients reporting cognitive impairment after treatment for breast cancer or lymphoma. In addition, recent studies also suggest that 1/3 of patients report difficulties with memory and processing information before they receive chemotherapy.
Vaccination is also an important area because cancer survivors are at elevated risk for infection due to cancer treatment, and appropriate vaccination of adult cancer patients is recommended as part of standard practice, but rates of compliance with recommendations are low. Sexual dysfunction is a common phenomenon among cancer survivors, often causing distress and reducing quality of life for patients, reaching up to 90 percent of prostate cancer survivors, 75 percent of rectal cancer survivors, and 50 percent of breast and gynecologic cancer survivors.
However, she noted that only a minority of cancer survivors reported that receiving treatment had an impact on their sexual function, and internists often reported a lack of knowledge on this issue, a lack of time to discuss it, and a lack of reference sources.
IV. Combination of Chinese and Western medicine in the treatment of tumors is the way to achieve the above goals
According to the viewpoint of combining Chinese and Western medicine, all current methods of treating diseases have their indications and limitations, and the treatment methods of Chinese medicine and Western medicine have their own advantages and disadvantages, while many advantages of Chinese medicine treatment are precisely the shortcomings of Western medicine treatment methods, and the advantages of Western medicine treatment are often the weaknesses of Chinese medicine treatment. Therefore, it is not only reasonable but also imperative to combine Chinese and Western medicine to complement each other’s strengths and improve the therapeutic effect.
For tumor clinic, the starting point of advocating the integrated treatment of Chinese and Western medicine is based on the full evaluation of the advantages and disadvantages of Chinese and Western medicine anti-tumor methods, and the planned integrated application of Chinese and Western medicine methods to bring their respective advantages into play, so as to obtain the maximum therapeutic effect while making the toxic side effects disappear or be minimized, so that patients can get better quality of survival and longer survival period.
At present, the main methods of treating tumors are surgical resection, radiation therapy, chemical drug therapy and biological therapy, while there are also unique Chinese medicine therapy, qigong therapy and acupuncture therapy in China. The treatment method of western medicine alone has better effect in eliminating local lesions and striving for radical cure, but there are many toxic side effects and the damage to pathological and normal tissues is not distinguished;
The treatment causes more medical origin diseases, such as surgical sequelae and complications, radioactive inflammation and sequelae, toxic hepatitis, bone marrow suppression, immunosuppression; the quality of survival and behavior of patients after treatment are poor; surgery, radiation and chemotherapy cause the body’s qi and blood depletion, disorders and dysfunctions of internal organs, etc.
On the contrary, Chinese medicine can improve the immune function of the body, reduce the toxic side effects of western medicine, reduce the production of medical diseases, improve the systemic symptoms, and make the tumor patient have a better quality of survival, thus improving the efficacy.
However, simple Chinese medicine treatment also has the disadvantages that it is difficult to eradicate the lesions completely, the effect of killing tumor cells is not strong enough, and the target of local lesions of tumor is not very high. Qigong and acupuncture treatment are also used as adjuvant therapy due to various conditions. For this reason, it is necessary to replace the previous Western medicine treatment or Chinese medicine treatment by the integrated treatment of Chinese and Western medicine. The combination of the two can synergize with each other and complement each other’s strengths, so that the long-term efficacy of tumor treatment can be improved continuously.
Integrative treatment of Chinese and Western medicine has been gradually valued and applied, but it is not common enough. Sometimes, patients often apply Chinese medicine treatment spontaneously while receiving Western medicine treatment. Some patients dare not cooperate with TCM treatment or carry out the treatment secretly by themselves due to the prejudice and opposition of competent physicians, so that it is difficult to truly carry out planned and reasonable integrated treatment of Chinese and Western medicine, which greatly reduces the efficacy. Thus, the concept of integrated treatment of tumors with Chinese and Western medicine should be established not only in the consciousness of patients, but also, and more importantly, in every tumor clinician.
In conclusion, the synergistic and complementary effects of two or more therapies in the integrated treatment of Chinese and Western medicine can obviously strengthen and improve the therapeutic effect; reduce and minimize various toxic and side effects, complications and sequelae in the treatment; consolidate the therapeutic effect and prevent recurrence and metastasis; regulate and restore the functions of the body and organs; alleviate the systemic and local symptoms caused by tumors; eliminate the adverse effects of patients’ thoughts and behavioral states caused by various factors; and improve the therapeutic effect of patients. It can also improve the quality of life of tumor patients and prolong their survival period.
Through this comprehensive therapy, which focuses on both helping the righteous and eliminating the evil, and taking into account the whole body and local area, the treatment of tumor can achieve more ideal clinical effect and comfortable feeling.