Treatment methods in oncology
Despite modern achievements in molecular biology, radiobiology, pharmacology, genetics, immunology and surgery, cancer still remains an elusive and unsolved puzzle for doctors, scientists, patients and their loved ones. This may sound disheartening in an era when traditional methods of treatment appear to be exhausted, but hope and an unwavering desire to live motivate people to consider even the wildest ideas. Many put their faith in alternative medicine searching for a miracle, and some even find one.
Treatment methods in oncology
We can conditionally divide these into four major groups:
Proven or tested methods that are supported by thoroughly planned and controlled clinical trials whose efficacy and results are generally agreed upon by a number of authorities and international organisations (FDA, EMA, ESMO, NCCN, NICE, et al.) and whose use is included in guidelines created by professionals in the field. These are, in the broadest sense, standard programmes of treatment, or combinations of treatments, which are recommended to combat and prevent the spread of specific tumours. However, the word proven doesn’t necessarily mean that all treatment medications work for all patients. In fact, the vast majority of so-called old treatments are also proven and are still included in a variety of guidelines. Unfortunately, there are relatively few clinical studies that compare and contrast both historically proven old cancer medications and new drugs. After all, proven doesn’t necessarily mean safe or well tolerated. People often fall into this semantic trap, falsely believing that if something has been proven to achieve results that it will always help. Moreover, if a new (innovative) drug has also been proven to work, people often believe that it must be better than the old treatment drugs. In some cases that might also be true, but not always. Every doctor will begin treatment with empirically proven methods and that is the correct approach. However, how many doctors are willing to listen to a patient’s objections, to take them into account and to prescribe a different method? I’ve personally observed that if a patient doesn’t have faith in a particular method of treatment, even if it is a proven method, the treatment won’t be effective, because the person’s entire being will resist the treatment. Therefore, it’s important to clarify why the patient isn’t willing to undergo traditional treatment, to see what their expectations and experiences are and to determine how well informed they are. I remember one patient who refused to agree to chemotherapy, despite the fact that, from my professional point of view, it was absolutely essential. Later, after speaking to her directly, it turns out that her sister had died while receiving chemotherapy for a tumour. Obviously, this was a huge trauma for her and it took me a long time to convince her. She finally agreed and finished the prescribed therapy. Patients also often give examples of other people who were given traditional treatments, but died anyway. These discussions aren’t easy, because we can only count on the patient’s acceptance of and compliance with a treatment if we gain their trust. But how do we achieve this trust, if the doctor can’t communicate with his patient?
Clinical trials are a method by which a patient is entered into a trial for a cancer treatment method and if the potential benefit is larger than the potential risk to the patient then it can be implemented in daily practice. This creation of a new drug is an incredibly expensive and lengthy process which begins in the laboratory and ends in the marketplace. Comprehensive trials are required to achieve this clinically proven and accepted status. In recent years the number of clinical trials has decreased significantly in Latvia and this is largely due to the small number of suitable patients, which hampers the recruiting process. However, in many cases participation in a clinical study is a unique opportunity for a patient to receive the very latest treatment method, which would otherwise not be available. For many years I worked as an expert consultant on Latvia’s State Agency of Medicines’ Commission on Licensing of Pharmaceuticals. Over the years patients’ consent forms have changed significantly. They grew longer and the informative text provided became more extensive and more direct. As I read the forms I remember thinking: my God, would I agree to all this? It is, however, an important document. I’ve often advised patients or their family members who have shown me the form and asked me whether or not they should agree to the trial. It all depends on the design of the study and exactly what is the subject of the study. There are times when I definitely attempt to convince the patient to participate in a study, because, given the conditions in Latvia, it could be a unique opportunity to receive treatment. Other times I try to understand if the patient is truly willing to accept potentially debilitating side effects and the possibility that the drug won’t work. We have to bear in mind that people are very different. A patient has the option to withdraw from a study at any time, but people often worry if they’ll be able to receive further treatment, which doctor will be willing to help them and, worst of all, if anything can still be done.
Integrative methods include methods when proven, traditional treatments are used in conjunction with complementary therapies. This approach has a slightly narrower focus than holistic therapy, but has become increasingly popular in Western Europe, perhaps as a reaction to clinically proven medicine, which effectively treats the illness, but often neglects the patient and his needs, forgetting that he is a person and not just a case number. After having participated for many years in summer camps organised by the Dzīvības koks (Tree of Life) patients’ support group, I’ve come to understand how important it is to use different approaches and different ways of viewing those afflicted by illness. Patients have told me how much they appreciate their physiotherapists and their healing touch. When you think about it, it’s possible that the patient doesn’t have anyone to provide them with basic physical contact. I’ve also heard many positive stories about a number of art therapy methods – colour, music, theatre, dance, pottery, etc. I agree that not everyone likes these methods and they’re not suited to everyone. In the camps we experimented to see who would like it and who wouldn’t. Either way, the patients appreciated that someone was attempting to engage with them. No, it’s not therapy in the literal sense of the word, but when applied together with traditional medicine, the benefit is greater. Currently there is no officially certified integrated therapy clinic for cancer patients. In Jūrmala, at the Cancer Virotherapy Clinic, we try to offer our patients art therapy, physiotherapy, psychotherapy, nutritional consultations and various exercises for mind and body. Our foreign patients often ask about truly alternative opportunities, which we don’t offer. I’ve come to believe that Latvians have a dismissive attitude toward homeopathy and other complementary methods, especially in oncology. Sadly, I’ve also noticed a large and unfounded bias against these methods. Physiotherapy for cancer patients? What are you on about! Even now, when it’s been proven that regular, controlled physical activity not only slows cancer growth, but also prolongs life for those afflicted by cancer and that certain physical procedures lessen pain, stress and spasms. I’m happy that our country is actively training such specialists who are enthusiastic young people who should be employed specifically as caregivers to cancer patients. I’ve also experienced a disdainful attitude toward art therapy. They claim that it doesn’t treat the illness. I agree that the treatment doesn’t affect the number of cancer cells in a patient, but it does affect their sense of wellbeing and general condition.
Finally, non-traditional methods, which encompass a variety of treatment methods whose efficacy in treating cancer has not been proven, but which are commonly used as both alternative and complementary treatment options. When I hear discussions about the efficacy of a variety of treatment methods, I often want to shout – hold on a minute! If these drugs have been proven effective in only 30% of patients, that means the other 70% are receiving drugs that have been proven to be ineffective as treatment, and oftentimes also toxic. Yes, many scientists are currently working to find markers that will help to better predict which concrete medication is the best solution for which patient. Unfortunately, even the current models of personalised medicine aren’t 100% effective for all patients.
I’ve come across this incomplete understanding of both alternative and complementary medicine from both patients and colleagues, which is why I’d like to spend a little time defining them.
Alternative therapy includes a variety of methods, which are implemented in place of traditional therapies. In this way, proven methods of therapy are delayed or even abandoned, which results in the spread of the disease. Alternative therapy is not a cancer treatment method. At the same time, society at large develops a twisted view about traditional cancer treatment methods, that they’re rarely effective. See, I went to the doctor with a diseased breast and nothing could be done. It’s not as uncommon as you might think that a patient visits an oncologist only after trying one of the so-called alternative methods once the disease has progressed. Then the opposite is surmised – while I was receiving non-traditional methods, everything was fine, but after visiting the oncologist everything got worse and the tumour grew larger. It seems absurd, but people do believe it.
Complementary therapy includes therapeutic methods and procedures, which are used in conjunction with traditional methods. The goals of complementary therapy can be diverse – to improve a patient’s general physical and emotional wellbeing, to change a patient’s lifestyle to improve their health, to increase the potency of traditional methods or to change the body’s internal environment to better cope with the side effects of cancer itself or the prescribed cancer therapy. It would be naïve to think that these methods are completely benign. There is a risk of a reaction due to the combination of different medications and the possibility of toxic effects on the body. It’s also possible that the patient or the person advising him could start to doubt the veracity or necessity of traditional treatments. In roughly half of cases, complementary methods are prescribed by doctors, including oncologists. These could be supplements, vitamins, antioxidants and other similar products, which are essentially legal and freely available nutritional agents. Not too long ago, society at large was up in arms over the suggestion to consider (not finance) the possibility of adding homeopathy as a method of patient care in the Ministry of Health’s new oncology plan. Then I’d like to ask another question – is it more important to buy a concrete supply of drugs or to attend to the patient’s general wellbeing while he struggles with the illness? If homeopathy helps a patient to fall asleep, decreases nervousness and allows him to feel more energetic, then I don’t see how that can possibly hurt.
Charlatanism and quackery includes any number of methods by which its apologists claim to cure, diagnose or protect one from cancer. In the majority of cases, it is offered by practitioners in good faith (usually without any medical education) who, with missionary zeal, defend their unique discovery that is based on the testimony of the supposedly “cured” and not on objective, scientific evidence.
Fraudulent therapy includes methods that could even be harmful or toxic, which are meant to exploit the desperation of cancer sufferers for monetary gain. Therapies are offered to prevent cancer, to treat the disease or to prevent a recurrence of the illness. It’s sad to acknowledge that this kind of medical subculture still ensnares patients in the 21st century. Sometimes we also see the opposite. A patient is convinced to undergo a proven therapy based on evidence from clinical trials, knowing full well that the treatment will most likely have no effect on the given patient’s illness. When one carefully reads about the efficacy and potential side effects of a registered medication, it’s possible that the percentage of adverse reactions will be higher than the overall proportion of patients for whom this drug has been proven effective. I understand that all doctors want to help within reason. But what if the “help” isn’t reasonable?