Quick Start: Things to Know
STANDARD OF CARE
Standard of Care (SOC) describes the protocols, guidelines, and recommendations that are in place for treating and caring for patients in a streamlined, predictable manner with a focus on the best possible outcome. SOC protocols are based on evidence-based research and real-world patient outcomes, and provide a clear path for clinicians to follow when approaching the development of an individualized treatment plan for a patient. SOC guidelines in cancer care are provided primarily by the NCCN (National Comprehensive Cancer Network) and are broken down into very specific categories and subcategories based on a patient's cancer type, stage, size/spread of cancer, specific location of cancer, inherited or acquired mutations, biomarkers, location of metastases, surgical candidacy, previous treatments, and other molecular, genetic, or biological characteristics of the cancer. The NCCN offers separate guides tailored to clinician and patient audiences, and updates are made on a regular basis. You may also see the acronym BSC, or Best Standard Care, in referring to Standard of Care.
EFFICACY, SAFETY, TOXICITY & TOLERABILITY
Efficacy is the term used to describe how effective (successful, beneficial, useful, powerful) a treatment is; how well the treatment works. The higher the efficacy, the better it works.
Safety is the term used to describe the amount of risk a patient takes on while receiving a treatment with regard to side effects and overall toxicity. A treatment's "safety" describes the likelihood of effects that can have a substantial impact on a patient's life including effects like: increased chance of infection; increased chance of serious disease in other organs/organ systems; and increased chance of weakness, instability, fatigue, for example.
Side Effects, or Treatment-Related Adverse Events (TRAEs), are the off-target effects of a drug or treatment; how your body responds to exposure to or use of a treatment. These can be positive, negative, or neutral effects, though they are most often used to describe unwanted effects. The term toxicity is often used interchangeably with negative/unwanted side effects.
Tolerability refers to how well a treatment can be tolerated (dealt with, endured, accepted) and how it relates to the length of time a patient can stay on the treatment (without discontinuation) despite negative side effects or toxicity. A well-tolerated treatment is one in which most patients can complete a course of treatment with little issue. A poorly-tolerated treatment is one in which patients experience higher levels of toxicity and may need to reduce dosage or discontinue the treatment altogether because the negative effects outweigh the benefits offered.
Choosing a treatment requires the consideration of both efficacy and side effects, and determining the balance between the two for the best individual outcome.
1ST, 2ND & 3RD LINE THERAPIES
The first-line therapy (1L) for your cancer type & stage is the first line of defense against your cancer and statistically the most likely option to be effective and/or tolerable (less toxic). The 2nd (2L) and 3rd-line (3L) options have been shown to be the next best choices if the previous line was ineffective, or if it had to be discontinued due to allergy or toxic side effects. Cancer develops resistance to treatments over time, so they don’t work as well or at all after a certain point. To combat the adaptive nature of cancer, multiple lines of therapy have been developed to attack cancer from different angles, at different times, and with different weapons. Given that each person and each cancer is unique, variations in response can occur; a patient may have a better response to a 2nd or 3rd-line than they did with the 1st, or they may not need to try a 2nd-line because the 1st was successful.
Think about this in terms of football. The team has a starting, or 1st string, quarterback and 2nd and 3rd-string backup quarterbacks. There’s nothing inherently wrong with the backups—they’ve proven themselves, just not to the same degree as our starter. Over time, we’ve learned that our 1st-string QB is more effective, more consistent with results, and has the highest chance of success. So, clearly, the 1st string is chosen to start the game because history has told us that he has the best chance of defeating our opponent. If he doesn’t perform at the expected level, then we’ll pull him out and throw our 2nd string into the game.
If you look at an FDA approved indication for a drug and it says, "for patients who have trialed/failed/progressed on A, B, or C..." then it's not indicated as 1st line treatment, but rather a 2nd or 3rd line treatment.
CURATIVE & PALLIATIVE TREATMENTS
Cure comes from the Latin “to take care of” and palliative comes from the Latin “to cloak”
- CURATIVE (KYEER-UH-TIV): to eradicate, cure, or completely kill/remove the cancer
- PALLIATIVE (PAL-EE-UH-TIV): to control, manage, stabilize, or prevent further cancer growth & metastasis
Each treatment option you encounter will either have an intent to cure or an intent to palliate. Whether a treatment is given for curative or palliative purposes will depend on the specific treatment you’re considering (have you had it before, did it work, does the data show a reliable response to this treatment for your cancer, is it for maintenance therapy or first-line treatment, etc.) and other factors including your cancer type and cancer stage. A chemotherapy drug, for example, may be given to you with curative intent, but the patient next to you may receive the same drug for palliative purposes. Many treatments for Stage IV cancers are considered palliative, not curative. Ask your oncologist if the treatments presented to you are intended to cure or control your cancer.
CLINICAL SIGNIFICANCE, RELEVANCE & ACTIONABILITY
Clinical Significance (sometimes called clinical relevance) describes how impactful a treatment is on a patient. A treatment is considered clinically significant if it has a noticeable, measurable impact on a patient and advances their healing, recovery, functioning, or improves the management of their condition or their quality of life.
Some tests and test results are referred to as clinically relevant. This indicates whether the test, or the result of the test, has a real impact on the care and condition of the patient.
Actionable is a word used to describe what can be done clinically with a piece of information, usually a test result of some kind.. For example, if there is a therapy available that targets a specific mutation you have in your cancer, then you can consider the results of that genomic report to be actionable since there is something you can do about that mutation—you can act on it. On the other hand, if your genomic report reveals mutations for which there are no targeted therapies, then those findings are not actionable. The bottom line is if you can use the information to make a medical decision, determine a treatment plan, choose additional tests, and/or select specific therapies/interventions, then that information is considered clinically actionable. Does the information impact, inform, or influence medical decision-making? If yes, it's actionable.
DIAGNOSIS & PROGNOSIS
A diagnosis is a determination given to patient regarding a specific condition or disease, as given by a physician or clinician, when the minimum guidelines have been met in terms of signs and symptoms, test results, physical exam, and other diagnostic measures. A diagnosis can include details about severity (stage) and other factors that may impact the treatment of the condition/disease.
A prognosis is a subjective predictive measure of the outcome of a disease based on clinician experience & expertise and retrospective patient data. In other words, the prediction is based on what a clinician has experienced with similar patients and what the data says about how patients before you have fared. A prognosis is an educated guess and can vary depending upon the clinician issuing the prognosis.
Simply put, a diagnosis is what you have and a prognosis is what that diagnosis may mean for your future.
Select a treatment Type below to learn more
Clinical Trials
Active Surveillance or Watchful Waiting
Active Surveillance or Watchful Waiting
Are clinical trials another treatment option for you? Learn the details about clinical trials in general, search for specific-to-you clinical trials that may be enrolling patients, and discover Compassionate Use
Active Surveillance or Watchful Waiting
Active Surveillance or Watchful Waiting
Active Surveillance or Watchful Waiting
Observation of the cancer using imaging and labs, without intervention or treatment
Response rates of FDA-Approved Cancer Drugs (2019)
