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Goals and rationale of cancer treatment
1World Health Organization Collaborating Centre for Quality of Life in Cancer Care, St Boniface General Hospital Department of Oncology, Winnipeg, Manitoba, Canada.
Objective:
To provide an overview of the goals and rationale for cancer management.
Data Sources:
Primarily the series "Changing concepts in the management of cancer" published in the Journal between December 1987 and September 1990 (see Box).
Study Selection:
Tumour types chosen for the series of articles were those with a high incidence, such as melanoma and tumours of the lung, breast and prostate, or curable tumours, such as acute leukaemias and lymphomas.
Data Synthesis:
Emphasis is placed on primary prevention, with lung cancer related to smoking as a model. Breast cancer serves as a model for secondary prevention and adjuvant therapy. The role of goal setting as the first step in cancer treatment is stressed. Some of the reasons why cure is now possible are discussed, as are criteria for the selection of tumours for adjuvant therapy and indications for starting palliative treatment.
Conclusions:
Cancer cure is no longer a myth but a reality. To overcome present barriers to the cure of some cancers, there is need for a better understanding of the biology of epithelial solid tumours including the mechanisms to overcome multiple drug resistance. The restoration of functional health after cure is attained is paramount. Quality of life as a measure of success should be included in all clinical trials.