Health State Descriptions for Canadians
82-619-MIE
Cancers
Context
Introduction
Summary table
The cancers
At diagnosis
Therapeutic
options
Subsequent
health states
References
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At diagnosis
This section presents the context and descriptions for 21 health states
that cover the course and treatment of cancer. These health states were
developed based on the cancers presented in The
cancers section.
For the purposes of this document, most cancers were classified according
to their likely prognosis, as well as therapeutic intent. These prognostic
groups are from Canadian Cancer Statistics.2
This classification was used on the assumption that cancers with similar
prognoses would have similar effects on individuals, in terms of limitations
to their functional capacities. (Descriptions for two types of leukemia
are provided separately.)
The prognostic category “very good”
(ratio of deaths to new cases [d/c] of 30% or less) includes the following
cancers: breast, prostate, bladder, testicular, uterine, thyroid, cervical,
melanoma1 and Hodgkin’s disease. These cancers
would generally be diagnosed at an early stage (almost 90% of breast cancer
patients are diagnosed at an early stage) and would be treated with curative
intent.
Cancers with a “fairly good” prognosis
(d/c of greater
than 30% but less than 50%) include colorectal, renal, oral and laryngeal,
non-Hodgkin’s lymphoma, and bone and connective tissue.2
These are often diagnosed at a later stage, or behave in an aggressive
fashion, which implies less chance for cure.
Finally, cancers classified as having a “poor prognosis”
(d/c 50% or greater)
include lung, pancreatic, stomach, ovarian, brain, liver,2
gall bladder,2 esophageal and multiple myeloma. These
are usually not diagnosed until the disease has progressed (approximately
70% of lung cancers are diagnosed at an advanced stage), and are treated
with palliative intent.
This classification approach applies to most, but not all, the cancers
listed above. Under certain circumstances, cancers which are considered
“curable” are diagnosed at an advanced stage, but highly effective
therapy is available. On the other hand, “poor prognosis”
cancers are sometimes diagnosed early enough to be treated with curative
intent.
This section provides generic descriptions based on a literature review
of the three most common cancers in each prognostic group. The patients’
physical and emotional states at the time of diagnosis of local or regional
disease are expected to apply to any of the cancers in the category (as
indicated in the descriptions). One health state at the time of diagnosis
of metastatic disease is also described.
1 Non-melanoma skin cancers are excluded from this classification
and from Canadian Cancer Statistics because they are usually successfully
treated without requiring hospitalization and because reporting procedures
vary across the country, making consistent registration of these cancers
difficult.
2 These cancers were omitted from Canadian Cancer Statistics
and have been classified based on case fatality data from the Surveillance,
Epidemiology, and End Results (SEER) Program.5
Cancers with a very good prognosis
| Description |
This description applies to the health state at diagnosis
of local or regional disease, prior to the commencement of treatment.
It describes patients diagnosed with breast, prostate and bladder
cancer, but also applies to cancer of the uterus, thyroid, cervix
and testis, melanoma and Hodgkin’s disease. Patients report
depression, impotence, urinary difficulties (for bladder and prostate
cancers) and impaired sexual functioning as well as decreases in self
esteem and self-image. Duration of this phase is estimated to be 37
days.6 |
| Classification |
Core |
Supplementary |
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Cancers with a fairly good prognosis
| Description |
This description applies to the health state at diagnosis
of local or regional disease, prior to the commencement of treatment.
It describes patients diagnosed with colorectal cancer, non-Hodgkin’s
lymphoma and renal (kidney) cancer, but also applies to oral and laryngeal
cancer and cancer of the bone and connective tissue. Many patients
with these cancers experience general malaise, fever, fatigue, loss
of appetite, decreased stamina, psychological distress (including
stress and anxiety) and impaired social and sexual relations. Duration
of this phase is estimated to be 37 days.6 |
| Classification |
Core |
Supplementary |
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Cancers with a poor prognosis
| Description |
This description applies to the health state at diagnosis
of local or regional disease, prior to the commencement of treatment.
It describes patients diagnosed with lung, pancreatic and stomach
cancer but also applies to cancer of the ovary, brain, esophagus,
gall bladder, liver and multiple myeloma. Marked loss of appetite,
weight loss, chest, abdominal or back pain, fatigue, depressed mood
and decreased physical functioning are common symptoms. In addition,
lung cancer patients often present with a persistent cough and dyspnea.
Duration of this phase is estimated to be 37 days.6
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| Classification |
Core |
Supplementary |
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Metastatic disease
| Description |
This description applies to any cancer that is diagnosed
after it has metastasized (spread to other parts of the body), generally
referred to as Stage IV disease. It also applies to any cancer that
is initially diagnosed at an earlier stage, but has metastasized at
the time of recurrence.
While radiotherapy and chemotherapy are viable therapeutic options
for treating metastatic disease, the treatment objective is palliative,
rather than curative. Surgical interventions may be necessary to
manage tumour-induced obstruction of the esophagus, bowel, bladder
or other structures, or to repair bones weakened by cancer that
have fractured. The functional limitations of patients living with
metastatic disease will be dependent on the site of metastasis.
Patients complain of pain severe enough to compromise daily functioning,
as well as progressive loss of strength and weight loss. Sadness,
grief and depression are also common in life-threatening illness.
Fatigue is a serious and disabling side effect of metastatic disease.
Many patients experience confusion and have difficulty concentrating.
In addition, social impairment, marital and relationship stress
and direct interference with sexual functioning can lead to high
levels of anxiety and feelings of helplessness and hopelessness.
Duration of this phase is estimated to be 37 days. |
| Classification |
Core |
Supplementary |
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 Chronic lymphocytic leukemia (CLL)
| Description |
This description applies to chronic lymphocytic leukemia
at diagnosis and before treatment. Many individuals with early stage
CLL
are asymptomatic, but may be identified during a routine blood
test when they present with infections, fatigue, or lymphadenopathy.
Individuals may live in this health state for long periods without
requiring therapy.
Patients with CLL
suffer from the discomfort of enlarged lymph
nodes and/or, liver and spleen, recurring infections, persistent
fatigue and night sweats. In addition, they may experience more
frequent hospitalizations, uncomfortable medical procedures, decreased
social interaction, stress over their chronic illness and fear of
death. |
| Classification |
Core |
Supplementary |
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Childhood acute lymphoblastic leukemia (ALL)
| Description |
This description applies to childhood acute lymphoblastic
leukemia at diagnosis and before treatment. Children with ALL
may
experience swollen lymph nodes, easy bruising, nosebleeds, frequent
infections and fever, and excessive sweating.
In addition, they frequently suffer from persistent fatigue due
to anemia, emotional strain, and anxiety; they experience separation
from their family when hospitalized, disrupted schooling and limitations
to their social lives. Children with leukemia are generally symptomatic
one to six weeks prior to diagnosis.
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| Classification |
Core |
Supplementary |
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