Outcome evaluation

Once a pathologic diagnosis of cancer is made, the patient may be evaluated by a radiation oncologist, a surgical oncologist, and a medical oncologist. Options for treatment are presented that may include surgery, radiation, chemotherapy, or some combination of these modalities. The goals of treatment will vary by the cancer and the stage of disease. For example, the patient who has metastatic kidney cancer could be cured by high-dose aldesleukin or receive palliative therapy with sorafenib or sunitin-ib or may decline any therapy because of fears of significant toxicity that would decrease quality of life. In this case, if the patient's performance status is poor, such as an Eastern Cooperative Oncology Group (ECOG) performance status 3, then the patient would not be a candidate for aldesleukin therapy because of significant toxicity or even death from treatment for a patient who has a performance status of 3. The patient with the poor performance status will receive palliative therapy to control symptoms of the disease to improve the quality of life at the end of life. For the patient with a poor performance status and extensive metastatic disease, no treatment of the cancer may be appropriate, and the patient may be enrolled in a hospice program or provided comfort care.

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