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

Introduction

Cancer cells are characterized by abnormal, uncontrolled and progressive growth. Malignant tumours tend to infiltrate the surrounding tissues and to give rise to distant metastases (spread of disease to other parts of the body away from the primary site).

Most cancers are classified using a staging system based on tumour size, extent of lymph node involvement, and evidence of distant metastasis. Generally, treatment options for early stage cancers (localized disease) are designed to achieve local control. Therapy for more advanced regional cancers aims at local-regional control, with a lower probability of “cure.”1 Cancers diagnosed at the most advanced stage have already metastasized to other parts of the body and, with a few exceptions, are treated with palliative intent to increase length of survival, maintain quality of life and treat cancer-related symptoms, when curative intent is not possible.

The psychosocial impact of a diagnosis of cancer cannot be underestimated. “Acute psychological distress is to be expected as a patient confronts the implications of cancer: possible death, pain, dependence on others, disability, disfiguring changes in the body, and loss of function, all of which endanger his or her relationships with others.”1 From this description, we can assume that for most cancers, patients experience the emotional impact created by the initial diagnosis, as well as the knowledge that they may have months of therapy ahead of them.

There is likely to be uncertainty and anxiety experienced while the cancer is “in remission,” until the individual is “cured” or relapses. Upon relapse, the patient is faced with more diagnostic and therapeutic options and more uncertainty. Patients who are told that there is no longer a way of curing the cancer must come to terms with the finality of their lives and with months of palliation and terminal care.

Top of Page

This document examines the functional limitations—physical, emotional and social—experienced by patients at the time of diagnosis of cancer and as they undergo the most common therapeutic modalities used, such as surgery, radiotherapy, chemotherapy and hormonal therapy (for prostate cancer). The long-term effects of these treatments are also examined, as are the functional limitations related to palliative and terminal care.

The document starts with an overview of progression and treatment for the three most frequently diagnosed cancers in each of three prognostic groups: bladder, breast, prostate (very good prognosis); colorectal, non-Hodgkin’s lymphoma, renal (fairly good prognosis); lung, pancreatic, and stomach cancer (poor prognosis). These nine cancers represent almost 72% of all (estimated) cases diagnosed in 2002.2 Two types of leukemia are also described: chronic lymphocytic leukemia (most common leukemia among adults) and acute lymphoblastic leukemia (most common leukemia among children).

The remaining sections provide descriptions and classifications for health states at diagnosis; while receiving treatment; and while in subsequent health states, including remission, palliation and terminal care. Readers should bear in mind that an individual will progress through various health states.

1 While it is generally acknowledged that cancer patients are not “cured,” clinicians approach therapy with curative intent.