At present, malignant tumor has become a common and frequently-occurring disease. According to statistics of relevant people, the number of cancer patients in China has remained above 2 million all the year round. With the change of people's lifestyle and some environmental changes brought about by economic development, malignant tumors such as colorectal cancer, lung cancer and breast cancer are on the rise in recent years, which seriously threaten people's health.
Reasonable combination of traditional Chinese and western medicine and individualized treatment are the better treatment options at present. At present, the treatment of cancer in the world has a complete system, and the curative effect has been greatly improved. Most patients can be cured in the early clinical stage, but the curative effect is poor for patients in the middle and late stage and patients with postoperative recurrence and metastasis. At present, the effective rate of treating malignant tumor is about 30% ~ 50%, that is to say, about half of patients can't be cured. There are a large number of patients with advanced cancer in society, which is a reality faced by clinicians.
Oncologists agree that the only goal of tumor treatment is not to eliminate tumors. At present, the evaluation standard of treatment effect has changed from simply observing the tumor inhibition rate to paying attention to the improvement of patients' quality of life.
"Quality of life" is an important topic in the medical field in recent years. The concept of quality of life is closely related to the redefinition of health standards and the change of disease spectrum. The World Health Organization defines "health" as a very good state of physical, mental and social activities, not just disease-free. It has become a comprehensive health evaluation index of physical, psychological and social adaptability. With the change of medical goal from acute infectious disease to chronic disease, more and more attention has been paid to whether treatment can make patients have a good quality of life. Introducing this concept of paying attention to quality of life into tumor treatment is conducive to evaluating the treatment methods and effects. With the development of medicine, the focus of medicine has shifted from "disease" to "human". While paying attention to local tumors, doctors should pay attention to the whole body and emphasize the quality of life, including the psychological, spiritual and social adaptability of patients. At present, the evaluation standard of treatment effect has changed from simply observing the tumor inhibition rate to paying attention to the improvement of patients' quality of life. Oncologists agree that the only goal of tumor treatment is not to eliminate tumors. If a treatment plan can make the patient live a few more months and shrink the tumor by a few percentage points, but at the expense of the patient's quality of life, then this treatment is actually meaningless.
What are the difficulties in improving the quality of life of patients with advanced cancer?
First, it is difficult to achieve "three mornings"
1. Many tumors have no symptoms or mild symptoms in the early stage, and lack typical symptoms, so patients can't take the initiative to see a doctor in the early stage, so about 75% ~ 80% have become patients with advanced tumors when they see a doctor.
2. There is no extensive census, and only a few people in the whole society can have regular physical examinations.
3. There is a lack of sensitive and specific methods to detect tumor markers in clinic.
4. At present, there is no specific method to treat tumor, or the chance of radical cure is limited.
Therefore, there is still a big gap between the reality and the "three mornings"-early detection, early diagnosis and early treatment. For more than half a century, great progress has been made in cancer prevention and treatment research in China. The treatment level of cancer patients in cancer hospitals in Beijing, Tianjin, Shanghai and Guangzhou is equivalent to or similar to that in western developed countries. However, because most patients can't find, diagnose and treat early, most cancer patients in China are in the middle and late stage.
Second, the situation is complicated and difficult to handle.
Patients with advanced cancer have the following characteristics:
1. In poor health, it is difficult to endure "aggressive treatment" such as surgery, radiotherapy and chemotherapy.
2. Although conventional therapies such as surgery, radiotherapy and chemotherapy were widely used in the past, there is no sign of repeated use at present.
3. There are many tumor complications and other chronic diseases.
4. Patients have an urgent desire to survive. Family and society want patients to get the best treatment to prolong their lives, but doctors suffer from no good plan.
These patients in the middle and late stage are not only seriously ill, with many symptoms, great pain, poor constitution and low quality of life, but also have a low clinical cure rate. Generally, the survival time of advanced patients is 3 ~ 6 months or 1 year.
Third, the overall understanding and treatment level of tumor patients who need long-term accompanying treatment needs to be improved.
Tumor is not a clinical emergency. Due to the improvement of medical level, the survival time of many cancer patients has been significantly prolonged, many of which are calculated by "years", and the number of long-term survivors is also increasing year by year. Some patients with prostate cancer and thyroid cancer. They may not die of cancer in the end, and even in the middle and late stages, they can live with the tumor for a long time. In such a long time, patients need medical assistance and guidance from specialists to solve many problems that affect the quality of life and complications that appear at any time. However, at present, the clinical specialties in China are too detailed, involving all departments of cancer. Most doctors are getting deeper and deeper in their own professional fields, but they seldom take into account the whole, and often can't make a comprehensive treatment plan. However, some specialized treatment methods need shorter treatment time, such as surgery and interventional therapy only need to be hospitalized for more than ten days, and radiotherapy and chemotherapy are mostly completed within 1 ~ 2 months, and there is no indication for re-treatment in the rest of the time. Patients are confused to go to the hospital, and they are often deceived, resulting in a worse quality of life and a shorter life span. Therefore, the problem of long-term accompanying treatment for cancer patients should arouse social concern, help patients to relieve symptoms, reduce or avoid new diseases, have a reasonable diet, combine work and rest, cope with psychological pressure and improve the quality of life in an all-round way.
Fourth, The Last Battle is often unsatisfactory, not as good as One Country, Two Systems and Dancing with Wolves.
Mr. Wang Lao is a patient with advanced lung cancer complicated with pleural effusion and a small amount of pericardial effusion. He is in poor general health and suffers from coronary heart disease and diabetes. According to common sense, he is not suitable for systemic chemotherapy. So at first, he only took local pleural effusion, intracavitary chemotherapy, systemic immunotherapy and comprehensive treatment of traditional Chinese medicine for strengthening the body resistance and eliminating evil. Results The pleural effusion was obviously controlled, and the primary lung lesions did not increase. After more than three years of adjustment and treatment, the patient's overall condition is good, pleural effusion is stable, but the lung lesions are slightly larger than before. At this time, patients and their families are not willing to "sit still and wait for death". They strongly demand the application of systemic chemotherapy to control the development of the disease and prepare for the "last fight". So I went to another hospital for two cycles of chemotherapy. After chemotherapy, the tumor focus did not shrink significantly. On the contrary, the patient's physical condition deteriorated sharply, chest tightness, dyspnea and other symptoms increased significantly, and serious lung infection occurred. Although after many treatments, he died in less than a month.
It can be seen that when the patient's physical condition is poor and the tumor load in the body is heavy, when aggressive treatment is carried out, cancer cells may end up with the patient's life.
Among the treatment strategies for patients with advanced cancer, some people choose "the last stop" (eliminating cancer) to prevent "waiting for death", while others think that "a narrow escape" can prevent "total annihilation" (surviving with cancer).
In recent years, with the development of humanization of medicine, we realize that birth, aging, death and illness are natural laws, and both healthy people and cancer patients should take "living well" and "living long" as their ultimate goals. Among them, "living well" is the foundation, and only a high-quality life can prolong life more valuable. Therefore, for patients with advanced cancer, active treatment that may not prolong life should be treated with caution; For some patients who do not have the indications of radiotherapy and chemotherapy, it is often counterproductive to blindly pursue local regression of tumors without considering the overall situation.
There are many advanced malignant tumors in clinic, and it is impossible to completely kill tumor cells by using various treatment methods at present. Moreover, due to the long-term consumption of tumors, patients are often in poor health and cannot bear the further blow of aggressive treatment. Faced with this reality, it is better to live in peace with "one country, two systems" or "dancing with wolves" than "tangle", "lose both sides" or even "mutually assured destruction".
It has long been pointed out that tumor is a long-term and chronic pathological product of itself, and effective treatment is not necessarily to eliminate all cancer cells. For example, although small cell lung cancer is easy to eliminate, the life span of patients may not be prolonged; Thyroid cancer and prostate cancer can coexist with tumors for a long time. Especially for some elderly patients, the function of various organs is weak, and there are many other chronic diseases. If they are treated excessively actively, their survival time will often be shortened due to serious side effects. Therefore, at this time, we should pay more attention to the overall conditioning and quality of life of patients.
Symptomatic treatment, adjuvant treatment and traditional Chinese medicine treatment are all essential links to improve the quality of life of patients with advanced cancer.
Adjuvant therapy should not be underestimated.
In the process of tumor treatment, adjuvant therapy is essential, especially for patients with advanced tumors. Adjuvant therapy has become one of the main treatment methods, and has often achieved good results. At present, some common chronic diseases, such as cardiovascular and cerebrovascular diseases, diabetes and rheumatism, are difficult to cure. For some long-term chronic diseases, it is not as fast and thorough as surgical appendectomy and antibiotics to treat pneumonia in children. Most of them seek a higher quality of life and a longer survival time under the condition of long-term illness. At present, adjuvant radiotherapy, adjuvant chemotherapy, supportive treatment, symptomatic treatment, psychotherapy, nursing of Chinese and western medicine are all important means of comprehensive treatment.
In the past, radical treatment and adjuvant treatment around surgical treatment were often divided into two completely independent stages, namely radical treatment and adjuvant treatment.
Nowadays, it is found that tumors need comprehensive treatment, and adjuvant treatment is very important for maintaining radical results and improving quality of life. We should not be divorced from radical cure, but should infiltrate and cooperate with each other. Therefore, the mode adopted should be: radical treatment+adjuvant therapy.
Symptomatic treatment can obviously improve the quality of life.
Many clinical symptoms of patients with advanced cancer are important factors affecting their quality of life, including physical and mental performance. In the aspect of symptomatic treatment, immunotherapy, interventional therapy and traditional Chinese medicine all have good curative effects. For example, the traditional Chinese medicine of nourishing the heart, calming the nerves and soothing the liver can mediate the mental state of patients, improve sleep and reduce the occurrence of depression; Traditional Chinese medicine for promoting blood circulation, dredging collaterals and promoting qi circulation has analgesic effect; Polygonatum sibiricum, Polygonum multiflorum Thunb, Ligustrum lucidum, etc. can promote hair regeneration. Traditional Chinese medicines such as Codonopsis pilosula, Atractylodes macrocephala and Dioscorea opposita can stimulate appetite and relieve digestive tract symptoms. Ginseng, angelica, astragalus and other traditional Chinese medicines can protect bone marrow and improve blood cells, and so on. Through these treatments, the symptoms of cancer can be alleviated and the quality of life can be improved.
On the one hand, the physical complications of long-term cancer patients come from the permanent damage caused by tumor treatment such as surgery, radiotherapy and chemotherapy, that is, the long-term complications of tumors; On the other hand, it comes from many clinical symptoms of the advanced tumor itself; At the same time, it also caused many psychological and social problems.
Here, I want to emphasize the psychological and social problems, because this problem is often ignored by medical staff and society. For example, patients with early breast cancer can be completely cured after surgery, radiotherapy and chemotherapy. However, the patient is distressed by the lack of a breast. In addition, the patient suffers from mental anxiety and treatment injuries, such as alopecia, sallow complexion, fatigue, pain, anorexia and edema of upper limbs. Sometimes, they will cause serious psychological barriers, thus affecting their quality of life, and even suicidal thoughts, thus undermining the therapeutic effect. Due to the clinical emphasis on radical cure and the neglect of symptomatic treatment, the quality of life of patients with partial complete remission and partial remission has obviously decreased, resulting in the phenomenon that doctors are satisfied and patients are sad, which makes some patients suitable for radiotherapy and chemotherapy give up treatment for fear of adverse reactions. Therefore, when treating cancer patients, clinicians should not only pay attention to "routine" treatment, but also realize the necessity of symptomatic treatment and palliative treatment, and cooperate with the implementation of psychotherapy to obtain the best curative effect.
At present, there are many methods of symptomatic treatment, and the curative effect is obviously improved compared with before. Such as pain caused by bone metastasis, pain caused by other cancers, malignant hydrothorax and ascites, cancerous fever, jaundice and brain edema. Another example is the treatment of nausea, vomiting, bone marrow suppression, constipation, diarrhea and functional damage of important organs (heart, liver and kidney) in radiotherapy and chemotherapy, which also has satisfactory results. Wait, symptomatic treatment gradually changed from a supporting role to a leading role.
Chinese medicine is a magic weapon to maintain and improve the quality of life.
Clinical medication of tumor in traditional Chinese medicine does not produce obvious toxic and side effects like radiotherapy and chemotherapy. Pay more attention to the balance between the whole and the patient's viscera, qi and blood, body fluid and meridians, and emphasize the treatment of diseases. Therefore, it can play a great role in maintaining the quality of life of cancer patients. The functional characteristics of traditional Chinese medicine are as follows:
1, Chinese medicine can slow down symptoms and improve mental state.
Traditional Chinese medicine can relieve many symptoms of tumor patients, such as pain, anorexia, cough and asthma, bleeding, diarrhea, constipation, numbness, insomnia and so on. And can reduce the occurrence of cachexia by increasing appetite and prolonging sleep time. Traditional Chinese medicine can also improve mental and psychological conditions and improve patients' physical and mental health. Clinically, it is common for some patients with advanced cancer to improve their spirits, increase their confidence, prolong their activity time and improve their quality of life after taking traditional Chinese medicine.
2. Traditional Chinese medicine has the function of two-way regulation.
The two-way regulation of traditional Chinese medicine is manifested in two aspects: first, it plays a balancing role in the over-high or over-low of some biochemical and immune indexes, and corrects some disorders of the body, thus helping to maintain the quality of life; Second, the combination of strengthening the body resistance and eliminating pathogenic factors has both the function of strengthening the body resistance and the anti-tumor effect. Although the effect of traditional Chinese medicine is slow, and the effect of reducing tumor is generally not as good as that of radiotherapy and chemotherapy, most of traditional Chinese medicines are non-toxic, which can eliminate evil without hurting righteousness, and support healthy energy without supporting evil.
3. Fuzheng traditional Chinese medicine can regulate immune function and restore physical strength of patients.
Traditional Chinese medicine has a large class of tonic drugs, which have the functions of benefiting qi and nourishing blood, nourishing yin and helping yang, and can improve the quality of life for patients with weak health. Clinical research and animal experiments have proved that these drugs have the functions of reducing the toxicity of radiotherapy and chemotherapy, protecting bone marrow, stimulating appetite, enhancing physical strength, improving sleep and mental state, preventing cachexia and delaying the failure of patients with advanced cancer. At present, the clinical application of Chinese patent medicine is not limited to Chinese medicine doctors, and the role of Chinese medicine in strengthening the body resistance and strengthening the foundation is being valued by western doctors, and it is becoming an important means to improve the quality of life by combining traditional Chinese and western medicine.