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The concept of cure in oncology

Editor’s commentary by Dr. Ricardo Caponeri

As oncologists, we are often asked by our patients when they will be cured and how they can be sure that cure is reached.

Cure is not an easy concept in oncology. Emil Frei III (1924–2013) teaches us that “cure” exists when the risk of disease relapse is the same as the risk of cancer development in healthy people matched by sex and age. This statistical concept is not fully understood by our patients, who are not comfortable with the idea of a probability of cure.

We are unable to cure metastatic disease, with few exceptions like germ cell neoplasm, but we can frequently improve quality of life and time to progression, sometimes for a long period.

We use adjuvant treatments to decrease the risk of relapse. A prolonged disease-free survival is almost seen as a “cure”, but whether it was reached can only be known after some time of follow-up. And we don’t consider the possibly high risk of secondary neoplasms and genetic syndromes, i.e. patients may be “cured” for one neoplasia, but have an increased risk of other cancers. Theoretically, according to Frei’s definition, they are not cured since their risk is higher than that of people of the same gender and age.

Thus, the question asked by Ripamonti et cols. is very important: “Is it possible to encourage hope in non-advanced cancer patients?

The study explores the relationship between hope, symptoms, needs, and spirituality in patients treated in a supportive care unit. The authors conclude that, in cancer patients, hope can be encouraged by clinicians through dialogue, sincerity, and reassurance, as well as assessing and considering the patients' needs.

“Cure” is not only a biological event, but “care” represents the core for healing the person independently of the course of the disease. The answer is that we must try to encourage hope and, as oncologists, we should consider expanding our role and involve ourselves more in the holistic aspects of cancer care.

Reference

 

Is it possible to encourage hope in non-advanced cancer patients? We must try.

C. I. Ripamonti, G. Miccinesi, M. A. Pessi, P. Di Pede, and M. Ferrari

Ann Oncol first published online December 17, 2015 doi:10.1093/annonc/mdv614


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