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Health State Descriptions for Canadians
82-619-MIE

Cancers

Context

Introduction

Summary table

The cancers

At diagnosis

Therapeutic options

Subsequent health states

References

Download chapter (PDF)

More information

At diagnosis

This section presents the context and descriptions for 21 health states that cover the course and treatment of cancer. These health states were developed based on the cancers presented in The cancers section.

For the purposes of this document, most cancers were classified according to their likely prognosis, as well as therapeutic intent. These prognostic groups are from Canadian Cancer Statistics.2 This classification was used on the assumption that cancers with similar prognoses would have similar effects on individuals, in terms of limitations to their functional capacities. (Descriptions for two types of leukemia are provided separately.)

The prognostic category “very good” (ratio of deaths to new cases [d/c] of 30% or less) includes the following cancers: breast, prostate, bladder, testicular, uterine, thyroid, cervical, melanoma1 and Hodgkin’s disease. These cancers would generally be diagnosed at an early stage (almost 90% of breast cancer patients are diagnosed at an early stage) and would be treated with curative intent.

Cancers with a “fairly good” prognosis (d/c of greater than 30% but less than 50%) include colorectal, renal, oral and laryngeal, non-Hodgkin’s lymphoma, and bone and connective tissue.2 These are often diagnosed at a later stage, or behave in an aggressive fashion, which implies less chance for cure.

Finally, cancers classified as having a “poor prognosis” (d/c 50% or greater) include lung, pancreatic, stomach, ovarian, brain, liver,2 gall bladder,2 esophageal and multiple myeloma. These are usually not diagnosed until the disease has progressed (approximately 70% of lung cancers are diagnosed at an advanced stage), and are treated with palliative intent.

This classification approach applies to most, but not all, the cancers listed above. Under certain circumstances, cancers which are considered “curable” are diagnosed at an advanced stage, but highly effective therapy is available. On the other hand, “poor prognosis” cancers are sometimes diagnosed early enough to be treated with curative intent.

This section provides generic descriptions based on a literature review of the three most common cancers in each prognostic group. The patients’ physical and emotional states at the time of diagnosis of local or regional disease are expected to apply to any of the cancers in the category (as indicated in the descriptions). One health state at the time of diagnosis of metastatic disease is also described.


1 Non-melanoma skin cancers are excluded from this classification and from Canadian Cancer Statistics because they are usually successfully treated without requiring hospitalization and because reporting procedures vary across the country, making consistent registration of these cancers difficult.
2 These cancers were omitted from Canadian Cancer Statistics and have been classified based on case fatality data from the Surveillance, Epidemiology, and End Results (SEER) Program.5


Cancers with a very good prognosis

Description This description applies to the health state at diagnosis of local or regional disease, prior to the commencement of treatment. It describes patients diagnosed with breast, prostate and bladder cancer, but also applies to cancer of the uterus, thyroid, cervix and testis, melanoma and Hodgkin’s disease. Patients report depression, impotence, urinary difficulties (for bladder and prostate cancers) and impaired sexual functioning as well as decreases in self esteem and self-image. Duration of this phase is estimated to be 37 days.6
Classification Core Supplementary
 

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Cancers with a fairly good prognosis

Description This description applies to the health state at diagnosis of local or regional disease, prior to the commencement of treatment. It describes patients diagnosed with colorectal cancer, non-Hodgkin’s lymphoma and renal (kidney) cancer, but also applies to oral and laryngeal cancer and cancer of the bone and connective tissue. Many patients with these cancers experience general malaise, fever, fatigue, loss of appetite, decreased stamina, psychological distress (including stress and anxiety) and impaired social and sexual relations. Duration of this phase is estimated to be 37 days.6
Classification Core Supplementary
 

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Cancers with a poor prognosis

Description This description applies to the health state at diagnosis of local or regional disease, prior to the commencement of treatment. It describes patients diagnosed with lung, pancreatic and stomach cancer but also applies to cancer of the ovary, brain, esophagus, gall bladder, liver and multiple myeloma. Marked loss of appetite, weight loss, chest, abdominal or back pain, fatigue, depressed mood and decreased physical functioning are common symptoms. In addition, lung cancer patients often present with a persistent cough and dyspnea. Duration of this phase is estimated to be 37 days.6
Classification Core Supplementary
 

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Metastatic disease

Description This description applies to any cancer that is diagnosed after it has metastasized (spread to other parts of the body), generally referred to as Stage IV disease. It also applies to any cancer that is initially diagnosed at an earlier stage, but has metastasized at the time of recurrence.

While radiotherapy and chemotherapy are viable therapeutic options for treating metastatic disease, the treatment objective is palliative, rather than curative. Surgical interventions may be necessary to manage tumour-induced obstruction of the esophagus, bowel, bladder or other structures, or to repair bones weakened by cancer that have fractured. The functional limitations of patients living with metastatic disease will be dependent on the site of metastasis.

Patients complain of pain severe enough to compromise daily functioning, as well as progressive loss of strength and weight loss. Sadness, grief and depression are also common in life-threatening illness. Fatigue is a serious and disabling side effect of metastatic disease. Many patients experience confusion and have difficulty concentrating. In addition, social impairment, marital and relationship stress and direct interference with sexual functioning can lead to high levels of anxiety and feelings of helplessness and hopelessness. Duration of this phase is estimated to be 37 days.

Classification Core Supplementary
 

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Chronic lymphocytic leukemia (CLL)

Description This description applies to chronic lymphocytic leukemia at diagnosis and before treatment. Many individuals with early stage CLL are asymptomatic, but may be identified during a routine blood test when they present with infections, fatigue, or lymphadenopathy. Individuals may live in this health state for long periods without requiring therapy.

Patients with CLL suffer from the discomfort of enlarged lymph nodes and/or, liver and spleen, recurring infections, persistent fatigue and night sweats. In addition, they may experience more frequent hospitalizations, uncomfortable medical procedures, decreased social interaction, stress over their chronic illness and fear of death.

Classification Core Supplementary
 

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Childhood acute lymphoblastic leukemia (ALL)

Description

This description applies to childhood acute lymphoblastic leukemia at diagnosis and before treatment. Children with ALL may experience swollen lymph nodes, easy bruising, nosebleeds, frequent infections and fever, and excessive sweating.

In addition, they frequently suffer from persistent fatigue due to anemia, emotional strain, and anxiety; they experience separation from their family when hospitalized, disrupted schooling and limitations to their social lives. Children with leukemia are generally symptomatic one to six weeks prior to diagnosis.

Classification Core Supplementary
 

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