Adjuvant therapy: Types, Types of cancer that uses adjuvant therapy, Limitations and Alternatives


The additional treatment recommended after completing the primary treatment, most often surgery or radiation, is called as adjuvant therapy.

August 13, 2018

Adjuvant therapy: Types, Types of cancer that uses adjuvant therapy, Limitations and Alternatives

The additional treatment recommended after completing the primary treatment, most often surgery or radiation, is called as adjuvant therapy. It is given to reduce the risk of cancer returning. Neo-adjuvant therapy is treatment given before the primary treatment to help it kill or remove the cancer more effectively. The types of adjuvant therapy vary based on the types of cancer they are used for, as well as the overall health of the patients.

Types of adjuvant therapy:

The most commonly used adjuvant therapy are:

Chemotherapy:

Chemotherapy is a cancer treatment that uses drugs to kill cancer cells by treating all cells. It is traditionally given through the vein of the patient, but are also available as pills on the market.

Hormone therapy:

Hormone therapy stops the production of certain hormones in an effort to stop their effect on cancer. Not all cancers are hormone sensitive. So each case will be first analyzed by the doctors to see if it can benefit from this type of adjuvant therapy.

Radiation therapy:

Radiation therapy kills cancer cells using a high powered energy beam, similar to an X-ray. It helps to target the original cancer site as well as the area around it. Radiation therapy can be given internally or externally.

Targeted therapy:

Targeted therapy works similarly to chemotherapy to kill cancer cells. The main and most important difference is that it only focuses on the cancer cells instead of treating the entire body.

Immunotherapy:

Immunotherapy is an emerging cancer treatment that shows promising results. Immunotherapy works to kill cancer cells using the body's natural defense system or own immune system.

Types of cancer that uses adjuvant therapy:

Adjuvant therapy is most beneficial for advanced stages or aggressive cancers. These cancers might either have structures around them, such as tumors, or are associated with a high risk of having cancer cells elsewhere in the body.
Following are a list of cancers that are commonly treated with adjuvant therapy:

Limitations for adjuvant therapy:

Adjuvant therapy may not be suitable for everyone as a certain level of health may be required. The patient should be physically able to handle additional treatment. For this reason, it is important for the patient to discuss their options with a doctor. Also it depends on individual how they will respond to the adjuvant therapy. If benefit from the extra treatment is enough so that it outweighs the drawbacks of potential side effects and the inconvenience of ongoing treatment, then the patient is considered as ideal for adjuvant therapy.
A young breast cancer patient who has had cancer spread to a large number of lymph nodes in the axilla, or armpit is an example of a good candidate. In this case although surgery is performed to remove the tumor within the breast and the lymph nodes in the axilla, there is still a high risk of having the cancer return both within the remaining breast or lymph nodes and spread to organs such as the brain, lung, or bones.
After the surgery, the patient is given adjuvant radiation therapy to the breast and lymph nodes to decrease the chance of the cancer coming back in the breast and lymph nodes. In addition adjuvant chemotherapy is also given to decrease the chance of the cancer coming back in the organs such as the brain, lung, or bones.
A patient should be healthy enough to handle adjuvant therapy. A patient with moderate to high risk of cancer recurrence, without any other serious illnesses, such as heart or liver disease, and with a good performance status is considered as ideal for adjuvant therapy.
ECOG Performance Status is a grading system that can be used to determine the performance status of a patient. The patients are classified in to different grades based on their current health and capabilities. These are:

  • Grade 0: The patient is fully active and able to carry on all activity
  • Grade 1: The patient is restricted in physically strenuous activity but ambulatory and able to carry out light housework, office work
  • Grade 2: The patient is ambulatory and capable of all self care but unable to carry out any work activities
  • Grade 3: The patient is capable of only limited self care while confined to bed or chair more than 50 percent of waking hours
  • Grade 4: The patient is completely disabled, and cannot carry on any self care. They are totally confined to bed or chair

Side effects with adjuvant therapy depend on what kind of treatment the patient are given. They may even be intensified depending on their current state of health and other treatment they have already been given. Understanding the treatment will allow people to prepare for it. For example, chemotherapy can take months to complete and can have high impact on patients. They might be unable to care for themselves at the time.
Certain preparations should be made so that people have additional support at home and during their treatments. They may even need to miss school or work.
As the effects of chemotherapy are cumulative, passing every day feels more difficult and challenging both physically and psychologically. People should talk to their cancer team regularly about how they are feeling during and after their primary treatment, which helps the team to make sure to grade the cancer accurately.
It is important for people to ask about potential side effects and what general preparations need to be made before taking the adjuvant therapy. If adjuvant therapy is too much for someone, their doctor should know before taking further steps in their treatment plan. Therefore it is important to inform your doctor how you feel after each treatment session.

Alternatives:

There is no true alternative to adjuvant therapy. As it is based on the risk of recurrence of cancer in an individual, doctors may recommend less intense adjuvant therapy treatments versus others. However, it is a decision that must be made based on each personal situation.
Although there is no alternative to adjuvant therapy, living a healthful lifestyle may be recommended. A healthy lifestyle based on good nutrition and regular activity may help people with cancer to live longer and increase their chances of survival.
A diet consisting of higher portion of fruits and vegetables and moderate exercise that includes 30 minutes of activity, five days a week has been shown to improve survival in cancer patients. These also include patient those with advanced stages.
Healthcare providers frequently encourage patients to participate in complementary therapies such as meditation, yoga, and acupuncture that can alleviate some of the side effects associated with the treatment.