What The Experts Recommend
Cancer treatment is at its most effective the first time that its used.
If youve undergone three or more chemotherapy treatments for your cancer and the tumors continue to grow or spread, it may be time for you to consider stopping chemotherapy. Even if you decide to stop chemotherapy, you may still want to explore other treatment options, including experimental ones such as immunotherapy.
Review the recommendations of the American Society of Clinical Oncologists and Choosing Wisely as you grapple with this decision.
Choosing Wisely is an initiative created by the American Board of Internal Medicine Foundation. Its aim is to foster a conversation between healthcare providers and the public about unnecessary medical tests and treatments.
To help you make your decision on when to stop chemotherapy, ask your oncologist these questions:
- Will continuing treatment make a significant difference in my cancer growth?
- What other experimental options are out there for me to try?
- Does it matter if I stop chemotherapy now or several months from now?
- If I stop treatment, will my side effects, such as pain and nausea, go away?
- Will stopping chemotherapy mean I stop seeing you and your team altogether?
Being open and honest with your oncology team is very important during this time. Be sure your treatment team knows your wishes. Also, be clear on what you need in the coming weeks and months.
Chemotherapy For Colorectal Cancer
Chemotherapy is treatment with anti-cancer drugs that may be injected into a vein or taken by mouth. These drugs travel through the bloodstream and reach most parts of the body. Chemo is often used to treat colorectal cancer.
Chemo may be used at different times during treatment for colorectal cancer:
- Adjuvant chemo is given after surgery. The goal is to kill cancer cells that might have been left behind at surgery because they were too small to see, as well as cancer cells that might have escaped from the main colon or rectal cancer to settle in other parts of the body but are too small to see on imaging tests. This helps lower the chance that the cancer will come back.
- Neoadjuvant chemo is given before surgery to try to shrink the cancer and make it easier to remove. This is often done for rectal cancer.
- For advanced cancers that have spread to other organs like the liver, chemo can be used to help shrink tumors and ease problems they’re causing. While it’s not likely to cure the cancer, this often helps people feel better and live longer.
Three Months Of Chemotherapy May Be Sufficient For Stage Iii Colon Cancer
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CHICAGO Patients with stage III colon cancer who stopped chemotherapy after 3 months had similar DFS at 3 years as those who continued chemotherapy for 6 months, according to a prospective analysis of six clinical trials presented during the plenary session of the ASCO Annual Meeting.
Nothing has really changed for the treatment of stage III colon cancer since 2004 when 6 months of oxaliplatin-based chemotherapy FOLFOX or CAPOX became standard of care with curative intent for patients,Axel Grothey, MD, oncologist at Mayo Clinic in Rochester, Minnesota, said during his presentation. The problem is long durations of therapy are associated with long-term toxicities that are debilitating for many patients nerve damage that causes numbness, tingling and pain that can persist for the rest of a patients life. Shorter duration of treatment without compromising efficacy would really benefit patients and health care resources.
Grothey and colleagues pooled data from six studies conducted in North America, Europe and Asia to determine whether 3 months of chemotherapy demonstrated comparable efficacy to 6 months. Researchers also evaluated potential differences with FOLFOX chemotherapy compared with CAPOX .
Beginning in 2007, researchers followed 12,834 patients from 12 countries for a median of 39 months.
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Reduction Of Chemotherapy Dosage
Among 109 patients 67% of the patients received both regimens sequentially. The majority 78% began with FOLFOX and changed during the course of disease to FOLFIRI, 21% of the patients received exclusively FOLFOX, whereas FOLFIRI chemotherapy regimens were used exclusively in 12% of patients. 43% received additional treatment with a biological agent.
Upon discretion of the treating physician, in most cases dosage was reduced to 80% of the protocol dosage. We therefore used reduction to 80% of protocol dosage as a cut off to investigate the clinical effectiveness of standard chemotherapy in patients receiving reduced dosage.
In 42% of our patients a dose reduction to 80% or less was performed during the course of chemotherapy. Those 46 patients who received a dose reduction, received in average 14 chemotherapy cycles in our clinic . Patients continuing on protocol chemotherapy doses, received 10.5 cycles . In more detail, the majority of chemo cycles in these patients were applied with reduced dosage. Average cumulative dosage and dose intensities for 5-Flourouracil, Irinotecan and Oxaliplatin were calculated for full dosage and dose reduction subgroups . As expected, relative dose intensities were significantly different. Even though a trend to a higher cumulative dosage can be observed, t-test revealed no significant differences for cumulative dosages.
Is Chemo Worth It For Stage 4 Colon Cancer
If you have stage 4 colon cancer, you are likely wondering, Is chemotherapy worth it? Your chances of surviving the treatment depend largely on how far the cancer has spread. You should talk to your healthcare team about your options. It is also important to consider the wishes of your family members. Some of them may want to know everything, while others may not care.
While stage 4 colon cancer used to have a grim prognosis, new treatments are improving the outlook. As a result, the five-year survival rate for patients with the disease has increased from around 15% to over 70%. However, this may not mean you should undergo chemotherapy.
As a stage 4 colon cancer patient, you may also be offered radiation therapy. While it is usually considered palliative therapy, it can still help you control symptoms. It can also shrink the tumor. However, it wont cure colon cancer.
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Treating Stage 0 Colon Cancer
Since stage 0 colon cancers have not grown beyond the inner lining of the colon, surgery to take out the cancer is often the only treatment needed. In most cases this can be done by removing the polyp or taking out the area with cancer through a colonoscope . Removing part of the colon may be needed if a cancer is too big to be removed by local excision.
Treating Stage Iii Colon Cancer
Stage III colon cancers have spread to nearby lymph nodes, but they have not yet spread to other parts of the body.
Surgery to remove the section of the colon with the cancer along with nearby lymph nodes, followed by adjuvant chemo is the standard treatment for this stage.
For chemo, either the FOLFOX or CapeOx regimens are used most often, but some patients may get 5-FU with leucovorin or capecitabine alone based on their age and health needs.
For some advanced colon cancers that cannot be removed completely by surgery, neoadjuvant chemotherapy given along with radiation might be recommended to shrink the cancer so it can be removed later with surgery. For some advanced cancers that have been removed by surgery, but were found to be attached to a nearby organ or have positive margins , adjuvant radiation might be recommended. Radiation therapy and/or chemo may be options for people who arent healthy enough for surgery.
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How Long Does Chemotherapy Treatment Last
Adjuvant or neoadjuvant chemotherapy is typically given over a period of three to six months. This is often broken up into cycles, which are periods when youll receive the drugs followed by time to rest and recover from the drugs effects. Each chemotherapy cycle usually lasts a couple weeks. The exact treatment time depends on the specific drugs given. For instance, you may receive chemotherapy only on the first day of a two- to three-week cycle, or you may get it once a week or over a couple of days. Then, after the break, another cycle begins.
What Happens During The End Stage Of Colon Cancer
A diagnosis of end-stage colon cancer is something nobody wants to hear. It is never easy to deal with a terminal disease, but understanding the symptoms, getting good palliative care, and receiving the mental support you need can help.
In end-stage colon cancer, cancer has spread to other parts of the body, treatment has failed, and death is generally fairly close.
Have you considered clinical trials for Colon cancer?
We make it easy for you to participate in a clinical trial for Colon cancer, and get access to the latest treatments not yet widely available – and be a part of finding a cure.
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Could It Come Back
For most people, colorectal cancer doesnât come back, or ârecur.â But in about 35% to 40% of people who get surgery with or without chemotherapy, the cancer may come back within 3 to 5 years of treatment. If this happens, it could be in the colon or rectum, or in another part of the body, such as the liver and lungs.
Testing Whether Less Is Okay
In 2007, the International Duration Evaluation of Adjuvant Chemotherapy Collaboration was established to gather enough clinical trial data to establish whether 3 months of adjuvant chemotherapy would be no less effective than, or non-inferior to, 6 months of adjuvant treatment in patients with stage III colon cancer. The six clinical trials conducted under the IDEA umbrella, which includes the NCI-funded CALGB/SWOG trial 80702, all randomly assigned patients with stage III colon cancer to 3 months or 6 months of adjuvant chemotherapy.
Funded entirely with public or philanthropic support, IDEA is the largest prospective study in colorectal cancer research ever conducted, Dr. Grothey said.
In the analysis of all the patients in the six trials, the 3-month adjuvant treatment course fell just short of the statistical bar to be considered non-inferior to 6 months of chemotherapy, with 74.6% of patients free of evidence of recurrence, known as disease-free survival, compared with 75.5% in the 6-month group.
But for patients with low-risk colon cancer, who accounted for about 60% of patients in the trials, at 3 years there was virtually no difference in disease-free survival: 83.1% versus 83.3%.
If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
Treating Stage I Colon Cancer
Stage I colon cancers have grown deeper into the layers of the colon wall, but they have not spread outside the colon wall itself or into the nearby lymph nodes.
Stage I includes cancers that were part of a polyp. If the polyp is removed completely during colonoscopy, with no cancer cells at the edges of the removed piece, no other treatment may be needed.
If the cancer in the polyp is high grade , or there are cancer cells at the edges of the polyp, more surgery might be recommended. You might also be advised to have more surgery if the polyp couldnt be removed completely or if it had to be removed in many pieces, making it hard to see if cancer cells were at the edges.
For cancers not in a polyp, partial colectomy surgery to remove the section of colon that has cancer and nearby lymph nodes is the standard treatment. You typically won’t need any more treatment.
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When To Stop Cancer Treatment
When you have cancer and you have tried many treatments without success, its hard to know when to stop treatment. Sometimes, even with the best care, cancer continues to spread. It is hard to accept, but the best thing for you at that point may be to stop the cancer treatment. Instead, you could focus on getting care to keep you comfortable and out of pain.
The following explains how to know when it is time to stop treatment and focus on end-of-life care. You can use this information to talk with your doctor about your options and choose the best care for you.
Cancer responds best to treatment the first time.
When you treat a tumor for the first time, there is hope that the treatment will destroy the cancer cells and keep them from returning. But if your tumor keeps growing, even with treatment, there is a lower chance that more treatment will help.
This is especially true for solid-tumor cancers, like breast, colon, and lung cancer, and sarcoma. Doctors know a lot about how these cancers grow or shrink over time and how they respond to treatment. They have found that treatment after treatment offers little or no benefit.
When is it time to think about stopping cancer treatment?
Still, almost half of people with advanced cancer keep getting chemotherapyeven when it has almost no chance of helping them. They end up suffering when they should not have to.
How do you know when to stop treatment?
Hospice care improves your quality of life.
What Is Colon Cancer
Colon cancer, which is also known as colorectal cancer, is the third leading cause of cancer-related deaths in men and in women in the U.S. and is expected to kill more than 52,000 people this year, according to the American Cancer Society.
The cancer starts in the colon or rectum, part of the digestive system. Doctors say it can be awkward for patients to discuss the symptoms, potentially delaying a timely diagnosis.
People are maybe sometimes uncomfortable about talking about that part of their body, Dr. Jennifer Inra, a gastroenterologist at Brigham and Womens Hospital in Boston, previously told TODAY.com.
A common warning sign is rectal bleeding, but other symptoms include iron deficiency anemia, abdominal pain, narrow stools, a change in bowel habits and unexplained weight loss.
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Can Cancer Spread While On Chemo
There are several options for colon cancer treatment, including surgery and chemotherapy. Surgery can shrink the tumor and may be recommended before or after chemotherapy. It can also be a helpful way to prolong a patients life. However, determining whether you are a candidate for surgery is complex. It will require the input of multiple doctors.
Chemotherapy is a type of treatment that kills cancer cells. While chemotherapy can help shrink the cancer tumor, there is always a possibility that it could spread. It is common for colorectal cancer to spread to distant parts of the body. Once it has spread to a distant site, it is known as metastasis. Most cancers that develop metastases will first appear in the lungs or liver, and then spread to other parts of the body.
Depending on the stage of the colon cancer, a doctor may prescribe chemotherapy with targeted drugs. These drugs work by interfering with the process by which cancer cells create proteins that blind immune system cells. Targeted drugs are usually reserved for advanced cancer patients.
Adjuvant Therapy For Colon Cancer: Impact Of Stopping Treatment Early
For patients with stage III colon cancer, early discontinuation of adjuvant chemotherapy leads to worse outcomesbut early discontinuation of oxaliplatin did not. These findings, which came from an analysis of the large ACCENT and IDEA clinical trials databases, were presented at the 2022 ASCO Gastrointestinal Cancers Symposium.1
Early discontinuation of FOLFOX or CAPOX was defined as receipt of 75% or less of the planned cycles, and this was associated with a significant and clinically relevant decrease in disease-free and overall survival. Although early discontinuation of oxaliplatin alone was not detrimental, patients who received less than 50% of the planned number of cycles of oxaliplatin did have poorer outcomes, said Claire Gallois, MD, of the Hopital Européen Georges Pompidou, Paris.
In patients being treated with the 6-month adjuvant regimen, it seems important to maintain the planned number of treatment cycles, she said.
The importance of oxaliplatin in the treatment of early-stage colon cancer is well established, but many patients cannot tolerate a full course. Relative dose intensity of oxaliplatin less than 60% has been associated with poorer outcomes.2,3
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How Is It Treated Or Managed
The treatment for late-stage colorectal cancer may include systemic chemotherapy, new immunotherapies, or targeted radiotherapy. All these options aim to reduce the number of cancer cells, thereby improving your symptoms. Immunotherapies harness your immune system to destroy cancer cells. Many patients are given two or three of these drugs.
Surgery is not typically an option at this point, although surgery to remove tumors from the liver has been demonstrated to help.
You will be given medication to control pain when it becomes necessary. As your cancer progresses, you may be given strong opioids. Anti-nausea drugs are often given, either to treat nausea caused by the cancer or the side effects of chemotherapy. If the lungs are involved, you might be put on oxygen.
Your doctor will also recommend treatments for your mental health, which might include meditation and therapy. Many patients and their families benefit from joining appropriate support groups. This is part of palliative care, which is not the same thing as hospice and does not always mean that there is no cure. Palliative care is about improving your quality of life, which might include helping you with diet and nutrition, the aforementioned mental health support, pain management, etc.