When someone is diagnosed with cancer, a doctor will present them with a treatment plan explaining their next steps.
Sometimes, their doctor will recommend additional treatment after they have completed their primary treatment, most often surgery or radiation. This is called adjuvant therapy. It is given to reduce the risk of their 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 patients themselves. Cancer specialists offer an overview of what people need to know about adjuvant therapy.
Types of adjuvant therapy
There are multiple types of adjuvant therapy used today. Mayo Clinic outline the cancer treatments that are most commonly used:
- Chemotherapy: Chemotherapy is a cancer treatment that uses drugs to kill cancer cells by treating all cells. It is traditionally given through the patient's vein, but there are also some chemotherapy 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 doctors will first analyze each case 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. Using the body's own immune system, immunotherapy works to kill cancer cells using the body's natural defense system.
Which types of cancer is adjuvant therapy used for?
Adjuvant therapy is most beneficial for advanced stages or aggressive cancers. Dr. Patrick Kupelian explained to Medical News Today that 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.
Dr. Kupelian is Vice President of Clinical Affairs in the Oncology Systems business at Varian Medical Systems. He outlines a list of cancers that are commonly treated with adjuvant therapy:
- Brain cancers
- Head and neck cancer
- Breast cancer
- Lung cancer
- Throat and stomach cancer
- Pancreatic cancer
- Colorectal cancer
- Prostate cancer
- Cervical cancer
- Endometrial cancer
- Ovarian cancer
- Bladder cancer
- Testicular cancer
Who is adjuvant therapy for?
Adjuvant therapy is not for everyone. Any cancer treatment is extremely taxing, and not every patient will be physically able to handle additional treatment. For this reason, it is important that people discuss their options with a doctor.
Cancer experts say that the ideal candidate for adjuvant therapy will benefit from the extra treatment, enough so that it outweighs the drawbacks of potential side effects and the inconvenience of ongoing treatment.
"One example [of a good candidate] would be a young breast cancer patient [who has had] cancer spread to a large number of lymph nodes in the axilla, or armpit," says Dr. Kupelian.
"Surgery is performed to remove the tumor within the breast and the lymph nodes in the axilla. This patient is still at high risk of having the cancer return both within the remaining breast/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 to adjuvant chemotherapy (to decrease the chance of the cancer coming back in the organs such as the brain, lung, or bones)."
Additionally, it is important that people are healthy enough to handle adjuvant therapy, adds Dr. Hanna Luu, a breast cancer specialist and CEO of OncoGambit, a web-based service that creates personalized cancer treatment plans.
"An ideal patient for adjuvant treatment consideration is 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," Dr. Luu told MNT. "We determine the patient's performance status using the grading system called ECOG Performance Status."
Dr. Luu outlines the different grades given to patients based on their current health and capabilities:
Grade 0: Fully active, able to carry on all activity
Grade 1: Restricted in physically strenuous activity but ambulatory and able to carry out light housework, office work
Grade 2: Ambulatory and capable of all self-care but unable to carry out any work activities
Grade 3: Capable of only limited self-care, confined to bed or chair more than 50 percent of waking hours
Grade 4: Completely disabled, cannot carry on any self-care, totally confined to bed or chair
Side effects with adjuvant therapy depend on what kind of treatment people 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. Chemotherapy, for example, can take months to complete and will leave patients 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.
Melissa Thompson, a recent breast cancer survivor and representative on the Patient and Family Advisory Committee at Memorial Sloan-Kettering Cancer Center, went through chemotherapy following a double mastectomy only weeks after giving birth to her first child. She offered advice to MNT on how to prepare for adjuvant therapy for other patients.
"Chemotherapy is just one chapter of a much larger story. At the time, it feels like it is never ending. As the effects of chemotherapy are cumulative, every day that passes feels more difficult physically and psychologically. For those about to have cancer treatment or those in it, know that eventually there is a light at the end of the tunnel and with that will come life and optimism."
People should talk to their cancer team regularly about how they are feeling during and after their primary treatment. This 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 for the disruption in their life. If adjuvant therapy is too much for someone, their doctor should know before taking further steps in their treatment plan.
Are there any alternatives?
There is no true alternative to adjuvant therapy. It is based on the risk of cancer returning in each case. Doctors may recommend less intense adjuvant therapy treatments versus others, but it is a decision that must be made based on each personal situation.
There are, however, some things that people can do to increase their chances of survival. A healthy lifestyle based on good nutrition and regular activity may help people with cancer to live longer.
"Currently there are no alternatives to adjuvant therapy, but complementary therapies may be recommended for patients," explained Dr. Luu. "Although the
"Meditation, yoga, and acupuncture can alleviate some of the side effects associated with the treatment, therefore healthcare providers frequently encourage patients to participate in these activities."