Do we need a new standard of care for colorectal cancer? (Super-aggressive approach might not be best)

Medical Xpress / University of Vermont / Clinical Colorectal Cancer / The Lancet Oncology ^ | Feb. 15, 2022 | Christopher J. Anker et al / Joanna Socha et al

[ConservativeMind]

In recent years total neoadjuvant treatment (TNT)—a potent new treatment approach for advanced colorectal cancer that confronts tumors with aggressive rounds of chemotherapy and chemoradiation followed by surgery to remove the cancerous tissue—has emerged as the standard of care.

TNT's strength is that, compared with traditional treatment regimens for the disease that sequence the majority of chemotherapy after surgery, it significantly lessens the chances that cancer will later return and metastasize, though research has yet to show it extends life.

But TNT can be harsh, impacting quality of life for many patients..

A new paper highlights a variety of new colorectal cancer treatments that take into account both a patient's likely health outcome and quality of life factors, entitled "The Potential for Overtreatment With Total Neoadjuvant Therapy (TNT): Consider One Local Therapy Instead.”

Dr. Steven Ades: "Our goal is to give context to key advances that have the potential to de-escalate treatment, so clinicians can translate the published outcomes in a way that will help them make decisions in partnership with their patients."

The paper concludes that an approach the authors call Total Definitive Treatment (TDT) is often a viable alternative to TNT in institutions with multidisciplinary teams experienced with the approach.

TDT involves a close watch and wait approach to look for whether disease is still present following radiation and chemotherapy, reserving surgery only for patients who haven't responded fully to chemoradiation and chemotherapy and not making it part of the initial treatment plan. Keeping organs intact mitigates many side effects patients mark as bothersome in surveys, including low anterior resection syndrome, or LARS, which saddles them with a range of unpleasant symptoms.

Similarly, for low risk patients, surgery alone may be sufficient without the need for radiation, which can also cause a range of unwanted symptoms.

[ConservativeMind]

This discusses an alternative to the super aggressive colon cancer approach known as “total neoadjuvant treatment (TNT).” TNT does not improve the death rate from colon cancer and leaves patients with more issues, long-term, than the alternative, “ Total Definitive Treatment (TDT).”

[ConservativeMind]

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[SaxxonWoods]

Use one those new fancy LED car headlights to look up in there.

[9YearLurker]

My family member was fine for decades after stage 4 surgery. Not so sure “wait and watch” (a la sending Covid patients home until their lips turn blue?) or grrater reliance on chemo and radiation would be better.

[DannyTN]

How about better preventive care.

After reading and watching some of Gundry’s stuff and other’s on gut health, this seems to be a very neglected part of preventive health care.

[Red6]

Standards of care should be mere recommendations.

They have become far more. Hospitals and doctors do not deviate, and insurance will not pay for anything else. The so called “standard of care” which is largely set by the FDA, CDC/NIH, DEA, pharma, and insurance companies (no conflict of interest there) is the gospel.

The people paying for this, the people who are affected (their body, their values), the so-called consumer basically gets told what they get by flow charted health care.

America has socialized health care with a private store front.

[Terry L Smith]

I underwent “TNT” in 2000. Yes, it ‘killed it’. It also ‘killed’ my prostrate to PSA levels of ‘point 2’, instead of ‘2.3’. It scarred the tube between my left kidney and nladder, so 5 years ago, I had to start having a time change item stent inserteed, to keep it open. I have had relocation surgeries of my coleostomy, due to portions of my large intestine not working right.

“You figure, flip James Bond over on that laser table in Goldfinger, with the radiatiion gun at the same angle, and that is what they did!”

To add, the chemo before and after was no fun, but the worst was this ... they wsre zhooting at a ball around my 2nd set of uhoh muscles, which made it torture to screaming going No.2!!!”

[pierrem15]

A few years ago a friend in New York was diagnosed with colorectal cancer.

The doctors asked him when he wanted to schedule his colostomy.

He replied that their treatment methods haven't changed much sense since Antietam.

He's still hanging on, but being treated in Houston.

[ConservativeMind]

Some further studies with grape seed extract activity on colon cancer:

Grape Seed Extract Halts Cell Cycle, Checking Growth Of Colorectal Tumors In Mice

“… documented a 44 percent reduction of advanced colorectal tumors in the animals… The number of live cells decreased by 92 percent in one cell line when the highest dose was given for the longest time period, which was two days, he said.”

https://www.sciencedaily.com/releases/2006/10/061018093946.htm

As colorectal cancer gets more aggressive, treatment with grape seed extract is even more effective, study shows

“It required less than half the concentration of GSE to suppress cell growth and kill 50 percent of stage IV cells than it did to achieve similar results in the stage II cells,” Derry says.

https://www.sciencedaily.com/releases/2013/01/130117105843.htm