Treat the patient or the cancer?
Do you think that treating the whole patient rather than just the cancer can improve their outcome?
Dr Gerhardt Attard, Institute of Cancer Research, London:
It's definitely important to treat not just the cancer but the whole patient. And we've become increasingly appreciative of this, especially in prostate cancer where we use hormone therapy, which has other side effects. And we increasingly will tailor the type of hormone treatment, and the level of androgen suppression we aim to achieve to the patient's other conditions, age, and preference. And this has been happening for many decades; for example we've used anti-androgens in patients who preferred not to use castration in certain settings of the disease. So this has always been a factor that's been considered, but as we improve our ability to identify the more aggressive cancers versus the less aggressive ones, and as we improve our personalisation of treatment, we will be in a better position to select treatment for a specific cancer in a specific patient, and minimise the side effects and risks of other conditions.
Professor Malcolm Mason, Cardiff University:
I would like to think that there is a shift towards a more holistic approach to patient care – that is one which looks at the whole patient. I think it's coming, especially for patients with very early disease with the whole question of whether they're going to have treatment at all, or whether they'll be managed by active surveillance. Then, if they're going to have treatment, what treatment? That's a very, complicated discussion, and it really does involve not only the patient, but their family too. It depends on all the other factors, for example any other illnesses they may have, what they expect from a treatment and how they feel about the possible side effects of treatment.
There's been a little bit of work in trying to make some sort of decision analysis tools for patients, and I've seen some research that's looked at that. I think it's promising, but it's quite complicated and hasn't really been taken up. Perhaps we need to look at that again and try and develop those sorts of things, because there's definitely potential there.
And of course, when it comes to advanced disease, and the question about whether and when we're going to use treatments - sometimes with quite major side effects and disadvantages - that's where we really do need to think about the whole patient, and again, just what they want. And it's got to be very much a joint decision, between, the patient, the doctor and their family.