Some uses of adjuvant therapy are now clearly defined and accepted. In other areas there are differences of opinion. There may be several acceptable alternatives depending on the preferences of physician and patient. Adjuvant therapy is a constantly evolving field, so an experienced and up-to-date medical oncologist should be involved in treatment planning from the time of diagnosis to explain and implement the latest developments.
• In Metastatic Disease A variety of treatment combinations have a significant chance of causing metastatic
tumors to shrink or stop growing. Cure is not usually possible in this situation, although improvement in
symptoms and tumor shrinkage may last for months and often many years. More aggressive and effective
combinations are being developed in clinical trials .
• Intensity of Treatment In the past, chemotherapy was often omitted if the white blood cell or platelet counts
dropped moderately (even if there were no symptoms or significant risk) or when minor gastrointestinal or
other side effects occurred. Sometimes a dose of chemotherapy would be modified or postponed because of
holidays or inconvenience, but this should be done as infrequently as possible. It is now recognized that these
practices are generally unwise.
For metastatic disease and especially for adjuvant treatment, it is generally felt to be important to give full doses and to avoid postponing regularly scheduled doses for minor reasons or for less than significant toxicity.
Attempting to be "kind" to a patient by making toxicity as tolerable and minimal as possible can decrease the chances of a good result from the treatment. The kindest thing a physician can do is make sure the dose is as close to the theoretical maximum safe dose as possible and is also given on time.
