Quality of Life and Cost Effectiveness Issues in the Management of Patients with Hepatic Metastases from Colorectal Cancer
The intent of this chapter is to focus on relevant quality of life and cost effectiveness issues of new treatment strategies for patients who have colorectal cancer that has metastasized to the liver. At the present time, there is no potentially curative treatment except surgical excision of metastatic lesions. There is a danger of rediscovering limitations of old treatments by use of new technologies, unless carefully designed trials are performed. Unless treatment results in prolonged survival, the detrimental effects on quality of life that often accompany these chemotherapeutic regimens argue strongly against their use. It may be that the current strategy for clinical and research efforts in this field should be reexamined. The optimum management of the patient with hepatic metastases may not be part of routine cancer therapy and may still be an important area to investigate. Is it advisable that no more patients with hepatic metastases should be treated by infusion techniques unless they agree to participate in an experimental protocol? Also, should a no treatment control arm be required in all therapeutic trials? Only with a no treatment control arm can the survival, quality of life, and cost of these treatments be assessed properly.
The treatment history presentation of a patient with hepatic metastases will focus the discussion on differences in therapeutic strategies for patients with this disease. Through comments on patient management, the opinions of the participants representing several medical fields, will be presented. It is our intent to develop this discussion concerning quality of life issues so that physicians can see how these important concerns can be integrated into treatment plans for patients with incurable cancer.
KeywordsHepatic Metastasis Adverse Side Effect Extrahepatic Disease Regional Chemotherapy Hepatic Perfusion
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