More oncologists are utilizing de-escalation in oncology treatment of some cancers with promising results, CNN reported July 5.
De-escalation is a method of scaling back the use of aggressive or uncomfortable treatment to improve patients' quality of life. The approach gives optimal care with less treatment, and research suggests it could benefit people with certain cancers, such as rectal, cervical, prostate and early breast cancer.
"I tell patients, 'I want you to live longer, but I also want you to live better,'" Ursina Teitelbaum, MD, a medical oncologist at Philadelphia-based Penn Medicine, told CNN. "Sometimes, we can give a two- or three-month chemo holiday. Patients love a chemo holiday, and then we can re-intensify again and not compromise the patient's outcome at all. Basically, this can spare side effects. So what can we de-escalate in the concentration of your therapy so that you not only live longer but you feel better? That is the goal."
Several recent studies found omitting some treatments does not impact patient outcomes.
- A study of late-stage cervical cancer found a low risk of cancer progression after a simple hysterectomy, with similar results to those after a radical hysterectomy.
- A study of more than 1,000 patients with rectal cancer found chemotherapy alone before surgery had similar outcomes of survival and recurrence to those with chemotherapy and radiation.
- A U.K. study found men who partner with their physicians to keep a close eye on low- to intermediate-risk prostate tumors avoid treatment that can cause life-altering complications and were at no higher risk of death than men who surgically removed their prostate or were treated with hormone blockers and radiation.
Younger patients have shown increased interest in de-escalation, and the approach has risen in young people diagnosed with certain cancers.
"One of the things that we're doing now is trying to get smarter to identify who those patients are who can be de-escalated and they'll still be fine," Lori Wirth, MD, medical director of the Center for Head and Neck Cancers at Mass General Cancer Center in Boston, told CNN. "Not all patients want exactly the same thing, and I think our job as clinicians is to really make sure that when there isn't just one cookie-cutter approach, when there are options, that we've really helped the patient explore what those options are and made sure that we're heading down a path that makes the most sense for that one particular patient."