Monday, 7 April 2014
Complementary and alternative
Complementary and alternative medicine
(CAM) treatments are the diverse group of medical and health care
systems, practices, and products that are not part of conventional
medicine and have not been shown to be effective.[19] "Complementary medicine" refers to methods and substances used along with conventional medicine, while "alternative medicine" refers to compounds used instead of conventional medicine.[20]
CAM use is common among people with cancer; a 2000 study found that 69%
of cancer patients had used at least one CAM therapy as part of their
cancer treatment.[21]
Most complementary and alternative medicines for cancer have not been
rigorously studied or tested. Some alternative treatments which have
been investigated and shown to be ineffective continue to be marketed
and promoted.[22]
Exosome research
Exosomes
are lipid-covered microvesicles shed by solid tumors into bodily
fluids, such as blood and urine. Current research is being done
attempting to use exosomes as a detection and monitoring method for a
variety of cancers.[15][16]
The hope is to be able to detect cancer with a high sensitivity and
specificity via detection of specific exosomes in the blood or urine.
The same process can be used to more accurately monitor a patients
treatment progress as well. Enzyme linked lectin specific assay or ELLSA has been proven to directly detect melanoma derived exosomes from fluid samples.[17]
Previously, exosomes had been measured by total protein content in
purified samples and by indirect immunomodulatory effects. ELLSA
directly measures exosome particles in complex solutions, and has
already been found capable of detecting exosomes from other sources,
including ovarian cancer and tuberculosis-infected macrophages.
Exosomes secreted by tumors are also believed to be responsible for triggering programmed cell death (apoptosis) of immune cells; interrupting T-cell signaling required to mount an immune response; inhibiting the production of anti-cancer cytokines, and has implications in the spread of metastasis and allowing for angiogenesis.[18] Studies are currently being done with Lectin Affinity Plasmapheresis (LAP),[17] LAP is a blood filtration method which selectively targets the tumor based exosomes and removes them from the bloodstream. It is believed that decreasing the tumor secreted exosomes in a patients bloodstream will slow down progression of the cancer while at the same time increase the patients own immune response.
Exosomes secreted by tumors are also believed to be responsible for triggering programmed cell death (apoptosis) of immune cells; interrupting T-cell signaling required to mount an immune response; inhibiting the production of anti-cancer cytokines, and has implications in the spread of metastasis and allowing for angiogenesis.[18] Studies are currently being done with Lectin Affinity Plasmapheresis (LAP),[17] LAP is a blood filtration method which selectively targets the tumor based exosomes and removes them from the bloodstream. It is believed that decreasing the tumor secreted exosomes in a patients bloodstream will slow down progression of the cancer while at the same time increase the patients own immune response.
Research
Clinical trials,
also called research studies, test new treatments in people with
cancer. The goal of this research is to find better ways to treat cancer
and help cancer patients. Clinical trials test many types of treatment
such as new drugs, new approaches to surgery or radiation therapy, new
combinations of treatments, or new methods such as gene therapy.
A clinical trial is one of the final stages of a long and careful cancer research process. The search for new treatments begins in the laboratory, where scientists first develop and test new ideas. If an approach seems promising, the next step may be testing a treatment in animals to see how it affects cancer in a living being and whether it has harmful effects. Of course, treatments that work well in the lab or in animals do not always work well in people. Studies are done with cancer patients to find out whether promising treatments are safe and effective.
Patients who take part may be helped personally by the treatment they receive. They get up-to-date care from cancer experts, and they receive either a new treatment being tested or the best available standard treatment for their cancer. At the same time, new treatments also may have unknown risks, but if a new treatment proves effective or more effective than standard treatment, study patients who receive it may be among the first to benefit. There is no guarantee that a new treatment being tested or a standard treatment will produce good results. In children with cancer, a survey of trials found that those enrolled in trials were on average not more likely to do better or worse than those on standard treatment; this confirms that success or failure of an experimental treatment cannot be predicted.[14]
A clinical trial is one of the final stages of a long and careful cancer research process. The search for new treatments begins in the laboratory, where scientists first develop and test new ideas. If an approach seems promising, the next step may be testing a treatment in animals to see how it affects cancer in a living being and whether it has harmful effects. Of course, treatments that work well in the lab or in animals do not always work well in people. Studies are done with cancer patients to find out whether promising treatments are safe and effective.
Patients who take part may be helped personally by the treatment they receive. They get up-to-date care from cancer experts, and they receive either a new treatment being tested or the best available standard treatment for their cancer. At the same time, new treatments also may have unknown risks, but if a new treatment proves effective or more effective than standard treatment, study patients who receive it may be among the first to benefit. There is no guarantee that a new treatment being tested or a standard treatment will produce good results. In children with cancer, a survey of trials found that those enrolled in trials were on average not more likely to do better or worse than those on standard treatment; this confirms that success or failure of an experimental treatment cannot be predicted.[14]
Hospice in cancer
Hospice
is a group that provides care at the home of a person that has an
advanced illness with a likely prognosis of less than 6 months. As most
treatments for cancer involve significant unpleasant side effects, a
patient with little realistic hope of a cure or prolonged life may
choose to seek comfort care only, forgoing more radical therapies in
exchange for a prolonged period of normal living. This is an especially
important aspect of care for those patients whose disease is not a good
candidate for other forms of treatment. In these patients, the risks
related to the chemotherapy
may actually be higher than the chance of responding to the treatment,
making further attempts to cure the disease impossible. Of note,
patients on hospice can sometimes still get treatments such as radiation therapy if it is being used to treat symptoms, not as an attempt to cure the cancer.
Symptom control and palliative care
Although the control of the symptoms of cancer is not typically
thought of as a treatment directed at the cancer, it is an important
determinant of the quality of life
of cancer patients, and plays an important role in the decision whether
the patient is able to undergo other treatments. Although doctors
generally have the therapeutic skills to reduce pain, Chemotherapy-induced nausea and vomiting, diarrhea, hemorrhage and other common problems in cancer patients, the multidisciplinary specialty of palliative care has arisen specifically in response to the symptom control needs of this group of patients.
Pain medication, such as morphine and oxycodone, and antiemetics, drugs to suppress nausea and vomiting, are very commonly used in patients with cancer-related symptoms. Improved antiemetics such as ondansetron and analogues, as well as aprepitant have made aggressive treatments much more feasible in cancer patients.
Cancer pain can be associated with continuing tissue damage due to the disease process or the treatment (i.e. surgery, radiation, chemotherapy). Although there is always a role for environmental factors and affective disturbances in the genesis of pain behaviors, these are not usually the predominant etiologic factors in patients with cancer pain. Some patients with severe pain associated with cancer are nearing the end of their lives, but in all cases palliative therapies should be used to control the pain. Issues such as social stigma of using opioids, work and functional status, and health care consumption can be concerns and may need to be addressed in order for the person to feel comfortable taking the medications required to control his or her symptoms. The typical strategy for cancer pain management is to get the patient as comfortable as possible using the least amount of medications possible but opioids, surgery, and physical measures are often required. In the past doctors have been reluctant to prescribe narcotics for pain in terminal cancer patients, for fear of contributing to addiction or suppressing respiratory function. The palliative care movement, a more recent offshoot of the hospice movement, has engendered more widespread support for preemptive pain treatment for cancer patients. The World Health Organization also noted uncontrolled cancer pain as a worldwide problem and established a "ladder" as a guideline for how practitioners should treat pain in patients who have cancer [13]
Cancer-related fatigue is a very common problem for cancer patients, and has only recently become important enough for oncologists to suggest treatment, even though it plays a significant role in many patients' quality of life.
Pain medication, such as morphine and oxycodone, and antiemetics, drugs to suppress nausea and vomiting, are very commonly used in patients with cancer-related symptoms. Improved antiemetics such as ondansetron and analogues, as well as aprepitant have made aggressive treatments much more feasible in cancer patients.
Cancer pain can be associated with continuing tissue damage due to the disease process or the treatment (i.e. surgery, radiation, chemotherapy). Although there is always a role for environmental factors and affective disturbances in the genesis of pain behaviors, these are not usually the predominant etiologic factors in patients with cancer pain. Some patients with severe pain associated with cancer are nearing the end of their lives, but in all cases palliative therapies should be used to control the pain. Issues such as social stigma of using opioids, work and functional status, and health care consumption can be concerns and may need to be addressed in order for the person to feel comfortable taking the medications required to control his or her symptoms. The typical strategy for cancer pain management is to get the patient as comfortable as possible using the least amount of medications possible but opioids, surgery, and physical measures are often required. In the past doctors have been reluctant to prescribe narcotics for pain in terminal cancer patients, for fear of contributing to addiction or suppressing respiratory function. The palliative care movement, a more recent offshoot of the hospice movement, has engendered more widespread support for preemptive pain treatment for cancer patients. The World Health Organization also noted uncontrolled cancer pain as a worldwide problem and established a "ladder" as a guideline for how practitioners should treat pain in patients who have cancer [13]
Cancer-related fatigue is a very common problem for cancer patients, and has only recently become important enough for oncologists to suggest treatment, even though it plays a significant role in many patients' quality of life.
Angiogenesis inhibitors
Angiogenesis inhibitors prevent the extensive growth of blood vessels (angiogenesis) that tumors require to survive. Some, such as bevacizumab,
have been approved and are in clinical use. One of the main problems
with anti-angiogenesis drugs is that many factors stimulate blood vessel
growth in cells normal or cancerous. Anti-angiogenesis drugs only
target one factor, so the other factors continue to stimulate blood
vessel growth. Other problems include route of administration, maintenance of stability and activity and targeting at the tumor vasculature.[12]
Hormonal therapy
The growth of some cancers can be inhibited by providing or blocking
certain hormones. Common examples of hormone-sensitive tumors include
certain types of breast and prostate cancers. Removing or blocking estrogen or testosterone is often an important additional treatment. In certain cancers, administration of hormone agonists, such as progestogens may be therapeutically beneficial.
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