Patients for whom the start of case management was early in the disease trajectory more often had conversations on medical treatments, main diagnosis and burden of treatment; all three topics may be particularly relevant to patients still receiving life prolonging or curative treatment.
Such adaptive approaches, although not curative, might prolong survival when curative therapy is unavailable or inappropriate.
In an editorial accompanying the new report in The New England Journal of Medicine, Dr. Meier and Dr. Amy S. Kelley wrote, "Physicians tend to perceive palliative care as the alternative to life-prolonging or curative care — what we do when there is nothing more that we can do — rather than as a simultaneously delivered adjunct to disease-focused treatment".
Patients between 75 and 85 years more often received life-prolonging or curative treatment than those over 85 years (26.6% vs. 15.8%, p < 0.001).
However, life-prolonging and curative treatment decreases as the illness progresses and at the end of life the main goal of treatment should be palliative-oriented for most people [ 4].
In the younger group those lacking capacity were more likely to receive life-prolonging or curative treatment at the end of life than were those of that age group with capacity, a difference not found in the older group.
Likewise, possibilities of palliative care may have been discussed less with patients for whom support by the case manager started early, because they were still focused on life prolonging or curative treatment.
However, those aged between 75 and 85 were more likely to receive mainly life-prolonging or curative treatment than those older than 8526.6.6% vs. 15.8%) at the expense of comfort care (73.4% vs 84.2%).
Identification of molecular targets on cancer cells has led to the design of novel drugs, which either used as single agents or in combination with chemotherapy, has prolonged survival in metastatic disease, or contributed to curative treatment in the adjuvant setting.
Preoperative CRT has been used in the comprehensive treatment of GEJ and esophagus cancers for decades and has shown good curative effects in local control and prolonged overall survival.
