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Health State Descriptions for Canadians




Summary table

The cancers

At diagnosis

Therapeutic options

Subsequent health states


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Subsequent health states


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

2 2 2 2 1 3

2 1 1 1 1

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

2 2 2 3 1 2

2 1 1 1 1

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

2 2 2 2 2 2

2 1 1 1 1

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

1 2 2 3 1 2

2 1 1 1 1


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

3 3 4 3 2 4

3 1 1 1 3

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

Classification Core Supplementary

4 4 4 4 4 4

3 1 1 1 4

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