Health State Descriptions for Canadians
82-619-MIE
Cancers
Context
Introduction
Summary table
The cancers
At diagnosis
Therapeutic
options
Subsequent
health states
References
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Subsequent health states
Remission
Patients are considered in remission after treatment when there is no
clinical evidence of cancer; more generally, remission refers to the period
following treatment. Patients may remain in this state until they die
from some other cause or they may have a recurrence of their cancer. While
in remission, patients do not exhibit any signs of cancer, but might experience
residual physical or psychological effects, most commonly from the treatments
received. In addition, many cancer patients “in remission”
live with the concern and fear that their cancer may recur. These definitions
were developed from literature and are based on three of the most common
cancers in each prognostic group. Individuals often undergo two or more
types of treatments and may experience the combined long-term effects
of multiple treatments.
Remission after surgery
| Description |
This description includes the long-term effects of having
had surgery only, not in combination with any other therapy. Fatigue,
insufficient sleep and insomnia are reported following surgery. Patients
requiring radical surgery frequently report severely restricted social
and sexual activities. Breast cancer patients experience numbness,
pain and swelling in the affected arm; lung cancer patients complain
of dyspnea; those having surgery for colorectal or prostate cancer
can experience persistent bowel and/or bladder problems. Anxiety and
psychological distress can result from follow-up visits. |
| Classification |
Core |
Supplementary |
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Remission after radiotherapy
| Description |
This description includes the long-term effects of having
had radiotherapy alone, not in combination with any other therapy.
Chronic fatigue and distress are frequently reported following radiotherapy.
While most side effects are temporary, there are some long-term chronic
reactions to radiotherapy that are permanent, such as radiation-induced
scarring of the tissues (e.g., lung fibrosis) or within the abdomen,
leading to bowel obstruction. Bladder and bowel cancer patients report
irritative bladder or bowel symptoms and rectal cancer patients may
experience inflammation of the rectum. Rarely, radiotherapy can lead
to the late induction of second malignancies. |
| Classification |
Core |
Supplementary |
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Remission after chemotherapy
| Description |
This description includes the long-term effects of having
had chemotherapy alone (at any level of toxicity), not in combination
with any other therapy. Many patients exhibit chronic fatigue (referred
to as off-treatment fatigue), energy loss, sleep dysfunction, problems
with memory and attention. Some women experience hot flashes and mood
alterations as well as sexual dysfunction (due to menopausal symptoms,
painful intercourse, poor body image or low libido) following chemotherapy.
Other side effects reported are employment and marital problems, familial
disruptions and anxiety. Damage to the reproductive system can result
in short- or long-term infertility and sexual problems for both men
and women. Second malignancies may occur years later as a result of
the chemotherapy administration. |
| Classification |
Core |
Supplementary |
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Remission after hormonal
therapy
| Description |
This description includes the long-term effects of having
had only hormonal therapy for prostate cancer, not in combination
with any other therapy. Patients may experience hot flashes and breast
tenderness, fatigue, lethargy, loss of libido and sexual impotence,
which can be temporary, long lasting or permanent. |
| Classification |
Core |
Supplementary |
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Recurrence
Cancer may recur after the initial treatment. A specific health state
for recurrence is not provided here. Cancer that recurs either locally
at the original cancer site or regionally is assumed to have similar effects
on the patient’s functional and emotional state as the initial diagnosis.
Recurrent cancer after an initial “curative therapy” may,
however, have a greater emotional impact because it represents a failure
to totally eradicate the tumour. If the cancer has metastasized to other
parts of the body at recurrence, the diagnosis of recurrence is likely
to have a far greater impact on the patient’s psychological state,
since metastatic disease is considered incurable. Some patients move between
remission and relapse several times. This most typically occurs with metastatic
breast cancer, but is becoming more common with other tumours for which
there are moderately effective therapies.
Palliative and terminal care
When cancer has advanced to the point where it is not considered curable,
the treatment approach is described as palliative. The objective of palliative
care is to provide the best possible quality of life and to extend survival,
if possible. This includes the use of any therapeutic option to relieve
pain or discomfort, as well as the provision of psychological, social
and spiritual support. Many patients experience a long period of palliative
treatment during which their tumour is controlled (breast cancer being
the best example); however, palliative care is defined here as the five
months of life prior to the terminal care phase (the last month before
death). The goal of terminal care is to provide supportive care when no
active anti-cancer therapy is available or suitable.
Palliative care
| Description |
This health state is defined as the five months before
the terminal care phase. Existential, physical, and psychological
well-being is generally improved following admission to a palliative
care unit. Patients may experience pain and fatigue of varying degrees
while in palliative care, as well as the side effects of the administration
of morphine (constipation, nausea, vomiting, sleep disturbances, mental
clouding and confusion). Many express concern that they can no longer
fulfill their roles in the family and cannot perform household duties.
Sadness, grief, anxiety and depression are common, as well as feelings
of isolation. |
| Classification |
Core |
Supplementary |
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Terminal care
| Description |
The health state of patients in the last month of life
is similar to that in the palliative care state, except for the severity
of the functional limitations experienced. For example, many patients
experience severe pain or discomfort during this phase. Generalized
weakness and fatigue can make even simple acts, such as feeding oneself,
difficult.
“The last weeks of life are especially dramatic, with increased
dependency, weakness, confusion, and inability to manage simple
functional and personal tasks such as bathing, walking and continence.”7
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| Classification |
Core |
Supplementary |
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