Progress in Cancer Quality of Life
This timeline of advances in quality of life for people with cancer was developed by the American Society of Clinical
Oncology (ASCO), which represents nearly 30,000 physicians who treat people with cancer and research new cures.
An interactive version, which includes timelines of advances against a range of common cancers, is available online
at www.CancerProgress.Net.
Overview
Dramatic improvements in management of side-effects – including pain, nausea, and infection – have radically
improved quality of life for patients undergoing cancer treatment.
Major advances include the development of potent anti-nausea drugs, which enable most cancer patients to
receive chemotherapy in an outpatient setting with minimal disruption to their daily routines. Treatments that
stimulate production of red and white blood cells have helped reduce the need for blood transfusions and the risk
of infections during treatment. Management of pain has improved, thanks in part to new standards from the
World Health Organization and medical societies. And recognition and treatment of distress related to a patient’s
cancer diagnosis is now considered an integral part of quality cancer care, as are a range of support services for
patients and families.
There is also a growing understanding of the needs of cancer survivors. With record numbers of survivors and a
growing body of information about the long-term health effects of cancer treatment, programs have been
designed to ensure that survivors receive the medical monitoring and guidance they need to maintain their health.
Timeline
1971 Breast Cancer
More limited mastectomy proven effective for early-stage breast cancer
While radical surgery had been routinely used to treat breast cancer, a more limited surgical procedure
called total mastectomy (removing just the breast tissue instead of removing the breast, chest wall
muscle and underarm lymph nodes) is confirmed to be as effective for women with early-stage breast
cancer. The procedure reduces pain after surgery and speeds recovery for patients. This advance paves
the way for future breast-conserving surgeries.
1974 Testicular Cancer
Antibiotic bleomycin helps reduce treatment-related side effects
Bleomycin (Blenoxane), an anticancer antibiotic, is approved by the FDA, and soon becomes part of
standard treatment for testicular cancer. The new drug is found to be an ideal component of
combination chemotherapy because, unlike other anticancer drugs, it does not suppress the bone
marrow’s ability to produce red and white blood cells. Patients who are able to maintain higher blood
cell counts are far less likely to experience treatment-related complications.
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1977 Breast Cancer
Many women can opt for breast-conserving surgery
Studies show that a procedure called lumpectomy – involving the removal of only the tumor, and not
the entire breast – followed by radiation therapy is as effective as mastectomy for women with earlystage
breast cancer. The finding helps dramatically reduce the physical and cosmetic side effects of
breast cancer treatment and enables women to recover more quickly after surgery and return to their
normal lives.
1977 Kidney Cancer
Removing just part of the cancerous kidney is proven safe and effective
Studies indicate that some patients with early-stage malignant tumors in one or both kidneys are
candidates for partial nephrectomy – surgery in which the tumor and only part of the kidney is
removed, as opposed to removing the whole kidney. This refined approach revolutionizes treatment of
such tumors, preserving patients’ kidney function and helping many to avoid the difficult experience of
long-term dialysis.
1978 Pancreatic Cancer
Modification of standard surgical technique leads to fewer complications for
patients with early-stage pancreatic cancer
Surgeons refine the standard surgical approach for removing pancreatic tumors, called the “Whipple”
procedure. The modified pylorus (stomach)-preserving approach takes less time to perform, requires a
shorter hospital stay, and results in similar survival outcomes. Patients treated with this new approach
also have a lower risk of long-term side effects, which can include gastrointestinal distress, ulcers,
cramping and dizziness.
1982 Colorectal Cancer
Limited surgery helps rectal cancer patients avoid colostomies
A new procedure called total mesorectal excision emerges as a new standard surgical treatment for
many patients with rectal cancer. The procedure involves removing only the cancerous region of the
rectum and surrounding tissues, while preserving the anal sphincter, an approach that allows patients
to maintain normal use of their bowels. Previously, nearly all patients with rectal cancer underwent
permanent colostomies (elimination of waste through an opening in the abdomen connected to a
colostomy bag).
1982 Prostate Cancer
New surgical approach helps preserve sexual and urinary function
A new, nerve-sparing approach to prostate removal surgery (prostatectomy) is introduced. For the first
time, some men are able to maintain sexual potency and urinary continence after their prostates are
removed.
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Mid-1980s Melanoma
Less extensive surgery found effective for removing melanoma tumors
Instead of the traditional practice of surgically removing up to two inches of skin and tissue
surrounding a melanoma tumor, clinical trials show that margins of three-quarters of an inch or less
around the tumor are sufficient. This refinement makes recovery easier and helps reduce the cosmetic
impact of surgery.
1985 Colorectal Cancer
Minimally invasive approach useful for some rectal cancers
Surgeons develop and refine transanal endoscopic microsurgery (TEM) – surgery performed via a scope
inserted into the anus to remove early-stage rectal cancers less invasively. This approach is especially
important as an option for patients who are too ill or elderly to undergo an open abdominal
operation.
1986 Global guidelines help ensure proper pain management
Pain is common among patients with advanced cancer but hasn’t always been well-managed. In 1986,
the World Health Organization issues clear guidance on the use of pain medications for cancer
patients, focusing on stronger, opioid-type drugs such as morphine. The guidelines address
widespread concerns about addiction, tolerance and abuse, which made some providers reluctant to
prescribe the drugs. Adherence to the guidelines has been found to provide reliable pain relief for up
to 90 percent of patients. In later years, other organizations, including ASCO, propose guidelines to
help doctors recognize and talk to their patients about pain and its management.
1987 Testicular Cancer
Researchers hone standard chemotherapy to increase effectiveness, minimize side
effects
A new standard of care is established when a trial shows that using the drug etoposide (Toposar,
VePesid), instead of vinblastine (Velban, Velsar), together with cisplatin and bleomycin (Blenoxane)
leaves more patients cancer-free and causes far fewer nerve and muscular side effects. Over time,
researchers also learn that many men respond well to three cycles of chemotherapy, rather than four,
and that patients who do relapse can generally be cured with one additional round of chemotherapy.
1987 Testicular Cancer
Some testicular cancer patients can forego chemotherapy
Studies show that many men with early-stage testicular cancer can forego chemotherapy after surgery,
and instead receive “active surveillance” (regular check-ups to monitor for cancer recurrence). When
cancer does recur, available drugs are generally able to cure the disease. This approach spares many
men from the side effects of possibly unnecessary chemotherapy, and is now the standard approach
for about 75 to 80 percent of patients.
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1989 Drugs to boost blood cells help patients finish cancer treatment, reduce infections
The FDA approves the drug epoetin alpha (Procrit, Epogen) to stimulate production of red blood cells
in patients with severe anemia, one of the most common and serious side effects of chemotherapy.
These drugs are soon joined by white blood cell-boosting drugs such as filgrastim (Neupogen) and
pegfilgrastim (Neulasta). The new treatments help reduce the need for blood transfusions and make
chemotherapy safer by reducing the risk of infections and related hospitalizations.
1990 Testicular Cancer
New surgical technique allows most men to maintain their sexual function,
fertility
After identifying the lymph nodes where testicular cancer is most likely to spread, surgeons begin
using a new surgical technique – called nerve-sparing or modified retroperitoneal lymph node
dissection – to remove the cancerous testicle and the affected nodes. Whereas previous surgical
techniques generally left men unable to ejaculate following surgery, this new approach spares key
nerves and tissue. Over time, refinements to the approach enable 95 percent of men with testicular
cancer to maintain their sexual function and fertility.
Early 1990s Laparoscopic surgery minimizes pain, recovery time for several cancers
Beginning in the 1990s, laparoscopic surgery – in which a surgeon makes several small incisions and
uses telescoping equipment to remove tumors – emerges as an alternative to traditional open surgery
for some cancers, including kidney, prostate and colorectal cancer. This new approach allows patients
to recover faster and experience less pain, without sacrificing effectiveness.
1991 Powerful anti-nausea drugs alleviate major side effect of cancer treatment
Ondansetron (Zofran) is approved by the FDA to prevent vomiting caused by chemotherapy and/or
radiation. The drug works by deactivating the nervous system’s natural trigger for vomiting. Other,
similar drugs are soon approved, including granisetron (Kytril), dolasetron (Anzemet) and palonosetron
(Aloxi). These and other anti-nausea drugs, like aprepitant (Emend), make it possible for most cancer
patients to receive chemotherapy in an outpatient setting, with minimal disruption to their daily
routines.
1992 Melanoma
Sentinel lymph node biopsy introduced to assess the spread of melanoma to
nearby lymph nodes
A surgical technique called sentinel lymph node biopsy becomes a less invasive way to assess whether
early-stage melanoma has spread to surrounding lymph nodes. The procedure involves surgically
removing the lymph node(s) that receives lymph drainage from the primary tumor – the “sentinel”
node – and then examining it under a microscope for evidence of cancer. If the sentinel node is cancerfree,
no further lymph nodes are removed and the patient is spared the previous practice of removing
multiple lymph nodes. This more conservative approach is easier on patients and reduces the risk of
post-operative side effects such as lymphedema. Later studies show that results of sentinel lymph node
biopsy are one of the most important predictors of risk for melanoma recurrence. This information
helps doctors determine which patients should be treated more aggressively to prevent their cancer
from returning.
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1993 Pediatric Cancer
Major study tracks long-term health of childhood cancer survivors
As more and more children are cured of their cancer, researchers realize the need to better understand
the long-term health effects of their cancer – and cancer treatment – as they age. In 1998, researchers
from centers across the United States and Canada launch the Childhood Cancer Survivor Study, the
first major study to monitor the long-term health of childhood cancer survivors. Over the coming years,
their research sheds light on major long-term risks for these survivors, from increased risk of heart
disease and stroke to secondary cancers later in life. These results enable physicians to monitor for
these effects and provide more timely care.
1990s Prostate Cancer
Watchful waiting introduced for men with early prostate cancer
Prostate cancer often grows very slowly, and many tumors that are discovered in an early stage will
never grow to the point of being life-threatening. To help avoid unnecessary treatments, doctors begin
to practice watchful waiting (also called active surveillance), in which treatment is delayed or replaced
by frequent exams and PSA testing for men with early-stage disease. This approach helps them identify
patients whose cancer is more aggressive and requires treatment, while sparing others from the
complications of unnecessary treatment.
1996 Breast Cancer
Sentinel lymph node biopsy introduced to assess breast cancer spread
An important study establishes a technique called sentinel lymph node biopsy as a standard part of
breast cancer surgery. The procedure involves removing the lymph node closest to the primary tumor –
the “sentinel” node – and examining it under a microscope for evidence of cancer. If the sentinel node
is cancer-free, no further lymph nodes are removed and the patient is spared the previous practice of
removing a large number of nodes and possibly larger sections of the breast. This more conservative
approach allows for easier recovery and reduces the risk of postoperative side effects such as
lymphedema, a painful swelling of the arm. If cancer is found, additional nearby lymph nodes are
assessed, and often removed, and the patient is treated with additional chemotherapy after surgery.
Recently, studies have shown that for some women, removing just the sentinel node may be sufficient.
1998 Pediatric Cancer
New chemotherapy regimen reduces side effects for children with Hodgkin
lymphoma
A National Cancer Institute-funded study shows that a chemotherapy combination regimen known as
ABVD (with the drugs doxorubicin, bleomycin, vinblastine and dacarbazine) can safely replace the
previous standard treatment for patients with advanced Hodgkin lymphoma. This new combination
dramatically lessens the side effects of cancer therapy for children with the disease, without affecting
overall treatment outcomes.
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2001-2004 Colorectal Cancer
First oral chemotherapy drug helps simplify colon cancer treatment
The FDA approves capecitabine (Xeloda) for patients with advanced (metastatic) colon cancer, and
later for patients with stage III colon cancer (cancer with limited spread in the surrounding tissue) who
have had surgery to remove the tumor. Capecitabine is a pill version of the widely used intravenous
chemotherapy drug 5-fluorouracil that offers comparable effectiveness with a more convenient way for
patients to receive their treatment. Recently, capecitabine has been combined with the drug oxaliplatin
(Eloxatin) as an initial therapy for metastatic colon cancer and for early-stage colon cancer.
2004 Colorectal Cancer
Laparoscopic colon cancer surgery effective, better tolerated
A study by researchers at multiple cancer centers finds that laparoscopic surgery to remove colon
tumors was as effective as conventional open abdominal surgery, and was associated with shorter
hospital stays and less pain after surgery. Laparoscopic surgery involves removing the tumor through
multiple small incisions and a telescoping camera device. This less-invasive approach is now widely
used.
2004 Colorectal Cancer
Chemotherapy and radiation before surgery reduce side effects for rectal cancer
patients
Results from a large clinical study show that giving chemotherapy and radiation therapy before, rather
than after, rectal cancer surgery reduces the risk of local recurrence (cancer recurrence in the pelvis,
near the original tumor). Survival was similar in both approaches, but because the pre-surgery
treatment regimen was more tolerable, it is now the standard approach for treatment of rectal cancer.
2005 Research sheds light on long-term health problems of cancer survivors
In the 1990s, researchers begin a major study of the long-term effects of cancer and its treatment,
focusing on survivors of childhood cancer. In 2005, the Childhood Cancer Survivors Study reports that
survivors’ risk of long-term health problems – including heart problems, second cancers and scarring of
the lungs – was five times greater than that of their healthy siblings. Similar results have been found
for survivors of other cancers with high cure rates, such as testicular cancer.
The results are helping oncologists and primary care providers monitor and better manage the longterm
health of the millions of cancer survivors alive today.
2005 Breast Cancer
Low-fat diet and regular exercise may reduce risk of breast cancer recurrence
Two large clinical trials suggest that lifestyle changes, including a low-fat diet and exercise, decrease
the risk of breast cancer recurrence and death in women with early-stage breast cancer. The findings
are among the first to demonstrate that healthy lifestyle changes can have a substantial impact on
breast cancer outcomes.
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2005 Leukemia
Drug approved to reduce oral sores caused by cancer treatment
Palifermin (Kepivance) is approved by the FDA to reduce the risk and duration of painful sores and oral
inflammation associated with chemotherapy in patients with blood cancers.
2005-2010 Testicular Cancer
Testicular cancer survivors face increased risk of second cancers, other health
problems
A major study finds that survivors of testicular cancer – especially those who received radiation or
chemotherapy – have double the risk of developing a second cancer three or more decades after their
initial diagnosis. Other research identifies an increased risk of cardiovascular disease and chronically
low testosterone. These findings highlight the need for doctors to continually monitor for long-term
health effects among the growing number of cancer survivors.
2006 Breast Cancer
Many breast cancer survivors experience fatigue
A large study shows more than one-third of long-term breast cancer survivors report elevated fatigue 5
to 10 years after their cancer diagnosis. Women in the study had completed all cancer therapies other
than tamoxifen (Novaldex). The findings suggest that persistent fatigue may be common among breast
cancer survivors, and heightens awareness of this symptom among healthcare providers and
caregivers.
2007 Breast Cancer
Shorter course of radiation therapy is as effective as less frequent radiation
therapy for early-stage breast cancer
Findings from the START Trial suggest that “hypofractionated” radiation therapy, which involves fewer
but larger doses of radiation delivered over a shorter period of time, is as effective as conventional
radiation for reducing the risk of cancer recurrence among women with early-stage breast cancer, and
does not cause greater damage to healthy breast tissue. Since traditional radiation therapy for breast
cancer can take five to six weeks to complete, this shorter course (as little as three weeks) is a more
convenient option for some patients and makes it easier to complete all cycles of treatment.
2007 Colorectal Cancer
Diet, exercise reduce risk of colon cancer recurrence
Patients who follow a low-fat diet and exercise regularly are found to have a lower risk of colon cancer
recurrence after surgery for early-stage disease, demonstrating that lifestyle factors can have a
significant impact on cancer recurrence. The results provide patients with new tools for reducing the
risk that their cancer will return.
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Late 2000s Psychosocial support becomes an integral part of cancer care
A growing body of research highlights the importance of providing “psychosocial” services to help
patients address depression, anxiety and other emotional challenges after a cancer diagnosis. In 2007,
the Institute of Medicine issues a report recommending that all cancer care providers make
psychosocial services an integral part of patients’ care, to improve their quality of life and help them
adhere to their cancer treatment. Since then, ASCO and other medical and patient groups have
developed additional guidance and information to help ensure that patients and their families receive
the support they need to maintain their well-being.
2008 Cervical Cancer
Minimally invasive surgery shown to be effective for cervical cancer
In a small study, researchers find that two minimally invasive techniques – laparoscopic and robotic
radical hysterectomy (removal of the uterus) with radical pelvic lymphadenectomy (removal of
surrounding pelvic lymph nodes) – are as effective as traditional radical hysterectomy and
lymphadenectomy in women with cervical cancer. The procedures, which are performed through small
incisions, are associated with less blood loss and shorter hospital stays than traditional, open surgery.
While both of the new techniques had already been put into limited practice, this study provided
evidence to support their widespread use.
2010 Breast Cancer
Removing fewer lymph nodes for some breast cancer patients does not impair
survival
Two large clinical trials confirm that less extensive lymph node surgery in women with early-stage
disease does not reduce their likelihood of survival. Specifically, researchers find that removing
additional underarm lymph nodes to look for breast cancer in women with limited or no disease
spread in the “sentinel” node – where cancer is most likely to spread – does not make a significant
difference in survival, compared to removing fewer nodes. Removing fewer nodes decreases the risk of
side effects, such as pain and swelling in the affected arm.
2010 Lung Cancer
Adding palliative care to standard chemotherapy improves survival for advanced
lung cancer patients
A head-to-head trial shows that patients who received standard chemotherapy along with palliative
care (specialized treatment to address the symptoms of cancer, but not treat the disease) immediately
after their diagnosis with advanced lung cancer lived three months longer and had a higher quality of
life than patients who had chemotherapy alone. Patients who received the combination approach were
also less likely to undergo aggressive therapy at the end of life, such as resuscitation.
http://www.cancerprogress.net/downloads/timelines/progress_in_cancer_quality_of_life_timeline.pdf