WHAT DO YOU UNDERSTAND BY PALLIATE CANCER TREATMENT (50%). 2- GIVE EXAMPLES OF WHAT TREATMENT MODALITY CAN BE USED FOR PALLIATION (30%). 3- GIVE ONE EXAMPLE OF A CANCER WHERE PALLIATIVE TREATMENT IS USED (20%)

WHAT DO YOU UNDERSTAND BY PALLIATE CANCER TREATMENT (50%). 2- GIVE EXAMPLES OF WHAT TREATMENT MODALITY CAN BE USED FOR PALLIATION (30%). 3- GIVE ONE EXAMPLE OF A CANCER WHERE PALLIATIVE TREATMENT IS USED (20%)

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Title: Cancer palliative treatment

1- What do you understand by palliate cancer treatment (50%).
2- Give examples of what treatment modality can be used for palliation (30%).
3- Give one example of a cancer where palliative treatment is used (20%)

The World Health Organisation defines (WHO) cancer as the major cause of death globally and estimates that 7.6 million people died of cancer in 2005. (1) Another estimate in the United States shows that by 2030 almost 20% of their population will be 65 years of age and older including those with cancer who will require comprehensive health assessment and symptoms management without compromising their quality of life. (2)

Palliative cancer treatment and care is one of the four basic components of cancer control effective programmes implemented by the WHO to reduce the cancer morbidity, mortality rate and improve the quality of life in cancer patients.
Palliative care is defined by the WHO as ‘’ an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual’’ (3).
There are two aspects in cancer palliation; palliative treatment and palliative care. (4,5)

(A) Palliative Cancer Treatment:
The aim of palliative cancer treatment is to improve the quality of life by relieving symptoms caused by cancer illness or side effects of cancer treatments and to prolong number of living years even in non-curable cases. (4,6) The treatment can be introduced at any stage during an illness to relief symptoms of sickness or pain such as Dexamethasone in Moderate Emetic Chemotherapy (7) and Opioids in treating cancer pain (8). In addition, palliative treatment can also be used in treating symptoms for example reducing the size of tumour mass by localised radiotherapy or surgery to relief pressure symptoms (4).
Palliative Cancer Treatments include the following:

• Palliative Chemotherapy:
Is the treatment with cytotoxic drugs to kill tumour cells, can be administered intravenously (IV), intramuscularly, orally or topically in some cases of skin cancer. Mainly the IV route of administration is associated with severe side effects while given in cycles followed by recovery period. Due to the aggressive blood cells destruction by cytotoxic drugs and rapid cell division of digestive tract, patient may develop signs of infections, bleeding, nausea and vomiting, hair loss or mouth ulcers. These symptoms are treated by prescribed medicines and tend to gradually ease during the recovery period or after the treatment is complete. Bone marrow transplantation and peripheral cell support to replace cell production could be considered in some cases following chemotherapy and/or radiotherapy. (9)
In many cases where chemotherapy is the curative therapy, patients are willing to accept the treatment side effects and compromise their quality of life in order to be cured. Examples of cancers cured by chemotherapy are: stage IV testicular cancer, early stage breast cancer and colon cancers, Hodgkin’s Disease, acute leukaemia and localised cervical cancer (10). However, the same strategy applies when the goal is palliative for example in cases like advanced breast cancer and colon cancers, lung cancer, pancreatic cancer and metastatic prostate cancer where the patient have no option but to adhere to the same treatment and suffer the same side effects in order to live longer and perhaps increase their quality of life.
• Palliative Radiotherapy:
Is a localised therapy of ionizing radiation in treating disease, it is also used to damage cancer cells in high frequency/energy rays to stop cells growth and division. Palliative radiotherapy is recommended when other treatments such as surgical tumour removal cannot be used. It helps in reducing symptoms associated of pain, bleeding and decreased function caused by tumour pressure for example brain tumour, spinal tumour and tumour near the oesophagus. It can be combined with chemotherapy, surgery or both. It is usually a one-time unrepeated course of treatment, the treatment plan include three treatments on day 0, 7, and 21. (11)
Side effects depend on the treatment dose and the treated part of the body. In most cases they are not permanent and controllable. Patient may experience skin reactions, loss of appetite and neutropenia. (9)

• Hormone Therapy:
Hormones help some types of cancer cells to grow, such as breast cancer and prostate cancer. In other cases, hormones can kill cancer cells, make cancer cells grow more slowly or stop them from growing. Hormone therapy as a cancer treatment may involve taking medications that interfere with the activity of the hormone or stop the production of the hormones. It may also involve surgically removing a gland that is producing the hormones. The type of hormone therapy depends upon many factors, such as the type and size of the tumor, patient’s age, the presence of hormone receptors on the tumor. (12,13)
Tamoxifen (Nolvadex®) is the medication of choice to treat breast cancer by blocking the effects of estrogen on the growth of malignant cells in breast tissue. However, tamoxifen does not stop the production of estrogen. (13)
Side effects may be severe, mild or absent and may include Headaches, Nausea and/or vomiting, Skin rash, Impotence and Decrease in sexual interest

• Biological Therapy:
This type of therapy uses the body’s immune system to fight cancer. It’s designed to boost the immune system, either directly or indirectly, by Making cancer cells more recognizable by the immune system, and therefore more susceptible to destruction. (13.14)
Types of biological therapies used include(13,14):
1. Nonspecific immunomodulating agents: stimulate the immune system to produce more cytokines and antibodies.
2. Biological response modifiers: produced in a laboratory and given to patients. Drugs used include interferons, interleukins, colony-stimulating factors, monoclonal antibodies, cytokine therapy and vaccines.
Side effects may include fever, chills, aches and fatigue. Other side effects include a rash or swelling at the injection site.

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