ONCOLOGY INSTITUTE OF VOJVODINA
Sremska Kamenica
Phone: +381 (0)21 480 5500
Fax:
+381 (0)21 6613 741
E-mail:
info@onk.ns.ac.rs
PAGE Prevention and treatment :About cancer treatment, stem cells therapy, Clinicla trials, Health care
Cancer prevention Prevention the 12 most frequent cancer localizations Breat self-examination Testicle self-examination Cancer treatment

CANCER TREATMENT

ABOUT CANCER TREATMENT

ABOUT CANCER TREATMENT
There are many types of cancer treatment. The types of treatment that you have will depend on the type of cancer you have and how advanced it is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. You may also have immunotherapy, targeted therapy, or hormone therapy.
New strategies of cancer treatment are genetic therapy and clinical trials. Genetic therapy identify destroyed or missing genes, which cause cancer development and they are replacing them with normal copies of genes. Patients are included in clinical trials and are given novel drugs which are in examination phase when standard treatment doesn 't give results.
Based on the fact that cancer is complex disease , the strategy of treatment is chosen by a multidisciplinary team of doctors (Oncologic Committee) which consist of: medical oncologist, oncologic surgeon, gynaecologist, pathologist, and doctors of other specialities when it is necessary.

SURGERY
Surgery is the oldest method of treatment and yet still the most common method of treatment. Approximately 60% of patients with cancer undergo surgery. A surgical treatment is often combined with chemotherapy and/or radiotherapy.

SYSTEMATIC THERAPY
Chemotherapy is a treatment using substances (cytostatic agent) that travel through the bloodstream, reaching and affecting cells all over the body. Besides many side effects that this treatment can cause chemotherapy is the most efficient treatment upto this day and age. There are 5 types of chemotherapy treatment:
Induction treatment of lymphoproliferative disease (Lymphoma, Hodgkin , Multiple myeloma, Chronic lymphatic leukemia).
Neoadjuvant and conversional chemotherapy , biological therapy - using cytostatic agents or /and monoclonal antibodies before surgical or radiation treatment to reduce tumor growth or tumor downsizing.
Adjuvant chemotherapy -the use of cytostatic agents in order to destroy the rest of tumor cells after the surgical treatment.
Palliative chemotherapy -therapy which has as a primary goal to facilitate symptoms caused by cancer.
Chemoprevention-therapy of the future based on restoring the normal cell function.

RADIOTHERAPY
Radiation therapy uses high doses of high-energy radiation in order to destroy tumor cells. Radiotherapy is used to treat the malignant and benign tumors either alone or in combination with other treatments (surgery, chemotherapy). It is considered as the local mode of treatment because its effect depends on the ability of absorption of ionizing radiation by irradiated part of the body. It is believed that about 50% of patients administered either as the main radiation therapy, or as an adjunctive therapy.

IMMUNOTHERAPY
A type of biological therapy that uses substances to stimulate or suppress the immune system to help the body fight cancer, infection, and other diseases. It is also used to reduce the side-effects of chemotherapy .

STEM CELL THERAPY

ABOUT THERAPY
Transplantation of peripheral stem cells in oncologic patients represents one of the treatment modalities. It is performed in patients who underwent a complete treatment but still there is a doubt that some malignant cells were left over in the organism, or in patients with the recurrent disease, immediately after the initial treatment. These patients, after separation of a stem cell from blood and its freezing, are given large doses of cytostatics, i.e. far larger doses of cytostatics anticipated by the standard protocols. High doses of cytostatics lead to destruction of tumor cells but unfortunately healthy blood cells as well. Patients's stem cells, during such treatment, are returned to patients, which creates new blood cells much faster and safer and does not allow creation of, often, fatal complications.

INDICATIONS FOR THERAPY
Patients with Hodgkin's lymphoma with bad prognostic parameters and after fast recurrence of the disease after initial treatment.
Patients with other forms of lymphoma, with the disease recurrence after a certain time after finalization of the initial treatment.
Patients diagnosed with multiple myeloma.
atients with refractive testicular tumor.
Patients with Jung sarcoma.
Patients with refractive ovarian tumor.
BPatients with refractive breast tumor.

PROCESS OF THERAPY
Process of operation is very complex, complicated, and delicate. It requires coordinated team work in accordance with the strictly controlled procedures. Such process of operation requires certain technical conditions and apparatuses. It is necessary to have a modern and functional sterile block or facility, as well as some storage facility for isolation apparatuses or collecting of stem cells, which is performed by a specific apparatus. The apparatus is similar to the one for dialysis. Furthermore, there are also sets for separation and all other technical apparatuses, which enable a safe and controlled collection of peripheral stem cells. A collected stem cell is checked at special counters, which is performed in order to be sure that we have collected a sufficient number of specific cells. The equipment is very expensive and complicated and it requires professional personnel.
Defrosting procedure is a simpler operation, but more complicated for the patient because it requires patient's isolation and a special intensive treatment. Up to that moment, the patient had received high doses of cytostatics with a conscious intention to destroy every possible survived malignant cell. Unfortunately, it is good to stress out that this procedure also destroys healthy stem hematopoietic cells. Besides returning of the patient's own young stem cell, we also help such stem cell in its maturing and growth with the most modern medicaments called growth factors. The recovery period lasts from 7 to 14 days and until now, we have performed such autologous transplantation in 10 patients with lymphoma and multiple myeloma. The arrival of Prof. Jean-Peire Lotz opens a new phase of high-dosage therapy and autologous transplantation in solid tumors of testicles and breast.

CLINICAL TRIALS

ABOUT CLINICAL TRIALS
Clinical trials are interventions in clinical research which are designed to test the efficacy and quality of new ways of treatment and diagnostic .Within clinical trials new methods of surgical and systematic ( treatment by drugs ) methods. However the main purpose of clinical trials are investigating the efficacy of novel drugs and implementing them in every day practice.

TYPES OF CLINICAL TRIALS
There are three types of clinical trials known as Phase I, II and phase III.
Before intiating a clinical trial , all preclinical studies mutst be done on human regarding the effect of novel drugs on tumor cells and cell cultures, and then reproduce on live cells and measure the quality and the effect of treatment and side effects.
Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a separate research question. Phase I: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects. Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety. Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely. Phase IV: Studies are done after the drug or treatment has been marketed to gather information on the drug's effect in various populations and any side effects associated with long-term use. We can distinguish two types of clinical studies based on wether they are conducted in one or many healthcare centers: unicentric and multicentric .If there are several Healthcare centers included in clinical trials from several countries then they are multinational clinical trials. Multinational trials give the best results because they include most number of patients, gather most number of healthcare experts and because of this reason they last shorter period of time, and the shortest period of time regarding including novel drugs in everyday practice.

THE ADVANTAGES AND DISADVANTAGES OF A PATIENT'S PARTICIPATION IN A CLINICAL STUDY
The main advantage of participation in a clinical study is the possibility to provide a patient with a new, efficient medical drug ( as a monotherapy or combined therapy with standard drugs) which provide greater benefit to a patient in comparison to the standard treatment. Furthermore, the supervision of patients who participate in clinical researches are far more of a greater quality which results often in a better attitude of patient toward treatment although it can be a significant burden for a patient.
On the other hand, the disadvantage of participating in a clinical study is the possibility of development of the side effects which can be more severe than the effects of the standard treatment. However, all clinical researches have the appropriate medical procedures for taking care of side effects. In addition to this, it is possible that thoroughout the clinical trial, procedures such as taking tumor tissue sample which doesn't help the concrete treatment may be taken, but these procedures in a long course of time have a broader significance and long lasting impact on a development of improved quality and cutting-edge treatments for future patients.

RIGHTS OF PATIENTS PARTICIPATING IN CLINICAL TRIALS
Before initiating a clinical study, patient must be given detailed and necessary information in a written and oral form about the purpose of a clinical study, procedures included in a treatment, description of the procedure or treatment, any potential risks or benefits and possible side effects. Patient must give an informed consent prior to the enrollement in a clinical study, in which is stated that a patient can refuse to participate in research at any given moment and that such an action will not jeopardize or affect the standard care of treatment.

NURSE CARE

NURSE CARE IN ONCOLOGY
Health care in oncology is multidisciplinary and multiprofessional. Health care is performed by a nurse, who, as a health care worker, has multiple functions as: performer of the medical health care, lecturer, counselor, researcher, and administrator.
These functions are performed by a nurse as a part of a medical team, where she or he, as the doctor's associate, participates in realization of their orders in medical, diagnostic, and therapeutic procedures, and as a part of a nurse team, where she or he treats the patient:
as efficient as possible through health care by implementation and evaluation of oncologic health care procedures,
provides expert and professional help from the domain of oncologic health care to other nurses and health workers, patients and their families; organizes various kinds of professional meetings for improvement of oncologic health care,
helps in realization of research projects by defining the problems from her/his domain and their impact to oncologic care and treatment efficiency,
helps the creation of work organization which enables the efficient and optimal oncologic care and development of professional nurse practice.

Continual medical education is performed at the following levels:
Clinics and Departments of health institutions,
Affiliates of nurses,
By participation at the professional seminars in the country and abroad.

Health care vision:
Nurses should independently perform health care,
Nurses have legally regulated standards of minimal qualification,
Nurses have standard obligatory permanent education,
Nurses have obligatory testing of knowledge.

NURSE CARE AT THE ONCOLOGY INSTITUTE OF VOJVODINA
Nurse care is conducted at all clinics and institutes with the aim of achieving the organized, systematic, individual, and continual health care. The following health care is implemented: general, semi-intensive, intensive, and special, depending on the patient's needs. It is also possible to implement a palliative care in accordance with the health politics of the Oncology Institute of Vojvodina and the program of the competent institutions.

Type of health care workers
Number
Nurses
200
Laboratory technicians
29
Radiology technicians
43
Physiotherapeutic technicians
3
Pharmaceutical technicians
3
Applied bachelor of ecological sanitary engineer
1
Number of health care workers, 2016




CANCER TREATMENT
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Oncology Institute of Vojvodina
Put doktora Goldmana 4
21204 Sremska Kamenica
Serbia