onkommon.com
Systemic therapy
Adjuvant therapy
Treatment after surgery aimed at cells nobody can see, and the hardest benefit to explain.
What it is
After a cancer is removed, microscopic cells may remain. Adjuvant chemotherapy, radiation, hormone or targeted therapy is given to reduce the chance those cells return as incurable disease.
The benefit is statistical and invisible: you will never know whether it worked for you personally. That is why the absolute benefit, how many people in a hundred like you avoid recurrence, has to be stated in numbers, not adjectives.
When it is used
- After breast, colorectal, lung or gastric surgery
- After a high-risk melanoma excision
- Where pathology shows adverse features
- When a recurrence-risk score supports it
How the decision is made
- The absolute benefit in your case, expressed as a number out of a hundred, not a relative percentage.
- Whether a genomic recurrence score would change the decision, often it removes the need for chemotherapy entirely.
- The toxicity you are accepting for that benefit, and for how long.
Decided here at the board and prescribed here; infusions and radiation at a partner unit near you.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- Recurrence-risk assessment, including whether a genomic score is worth doing
- The absolute benefit written as a number
- A written toxicity expectation
- Cycle-by-cycle review and dose management
Performed and billed elsewhere
- Drug supply and administration
- Radiation delivery
- Adjuvant treatment is preventive, not curative of visible disease. If anyone tells you it guarantees you will not relapse, that is not true.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- What is my absolute benefit, out of a hundred people like me?
- Would a genomic score change this decision?
- What am I accepting in side effects for that benefit?
- What happens if I decline?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Breast cancer
Including hormone-receptor positive, HER2-positive and triple-negative disease
Colorectal cancer
Colon and rectal cancer, bowel cancer
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Stomach cancer
Gastric cancer
Skin cancer & melanoma
Melanoma, basal cell and squamous cell carcinoma
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.