The determination of a treatment plan takes into account a number of factors and variables. The aim of treatment for cancer may be cure, control and prolongation of life, or palliation of symptoms. These goals are re-evaluated when an individual's disease status changes.1
- Accurate diagnosis and staging is imperative to inform treatment options and decisions.2
- Tumour size, anatomic location, histology, sensitivity to antineoplastic agents, biological or targeted therapies or radiation, natural history and related survival statistics are also considered.3
- Prognostic factors and risk factors identified in staging can determine the need for standard approaches or recommendation for participation in clinical trials.1
- Treatment decisions may vary in complexity depending on disease types. While some diseases have established therapeutic regimens, for others research data have not led to prescriptive guidelines.2
- Evidence of treatment effectiveness can also be considered in conjunction with questions about affordability.2
Clinical perspectives also need to consider a range of personal factors. Choice of therapy can be influenced by a person's:2-4
- general health
- demographic variables, such as age, sex, financial status, education and geography
- external factors such as media, family and friends
- psychological factors, such as body image concerns
- performance status
- preferences, values, and beliefs.
Recognising these individual factors has been identified as important to ensure a health care approach which is sensitive to the needs and expectations of the person affected by cancer.
Standardised methods of assessing responses to treatment and individual factors (such as quality of life and performance status) form an essential element of treatment planning and informed decision making throughout the care continuum.
Performance scales that measure an individual's functional status may be used in eligibility criteria for clinical trials, and also to determine an individual's prognosis and survival time. A person with a lower functional score may have reduced likelihood to respond to treatment favourably.5
The most commonly used performance scales are the:
The Psycho-oncology Outcomes Database (PoD)
PoD5 is a searchable online database of validated psychosocial and quality of life measures that assess a broader range of domains than performance status alone. The database contains information about more than 350 patient-reported outcome measures, focusing on outcomes such as quality of life, supportive care needs, psychological states and social support. Access to PoD is free via the Psycho-oncology Co-operative Research Group members' website. (This is a free resource but you must register as a member and then click 'Remember me' to bypass the login page in future)
Review the record of an individual in your health care facility who has recently been diagnosed with cancer, and where possible interview them.
- Identify their cancer diagnosis
- Describe the disease, treatment, and individual factors that were considered in the treatment planning process.