NCCN Guidelines for Patients
: Caring for Adolescents and Young Adults
Part 4: Navigating the treatment process
Getting treated for cancer can be a strange journey. You
know where you want to end up—healthy—but it’s not
always clear how you’re going to get there or how long it
will take. Depending on your diagnosis, the process could
take weeks, months, or years, hopefully to be followed by
many more years as a cancer survivor.
Stages of treatment
Cancer treatment is rarely a one-shot deal. Most patients
go through several rounds of treatment to make sure
the cancer is either gone or under control. Although the
specific therapies used during each stage will depend on
your particular diagnosis, your treatment plan is likely to
take you through several of the following stages.
Neoadjuvant or induction therapy
Neoadjuvant (from Latin words meaning “new aid”)
or induction (“to lead into”) therapy is usually given to
reduce the size of the cancer before cancer surgery.
It can be particularly helpful for a large primary tumor,
because shrinking the tumor may make the surgery
less complicated. Induction therapy may also be used
to prepare the body for a stem cell transplant (or bone
marrow transplant) in patients with leukemia or lymphoma.
Neoadjuvant therapy may include radiation therapy,
chemotherapy, or a combination of several different
treatments. If the chosen treatment carries a risk of side
effects such as nausea or fatigue, the treatment team
should also set up a palliative care plan to prevent or
relieve these symptoms.
If the cancer does not change or continues to grow during
neoadjuvant treatment, your doctor may try a different
therapy (for example, a different chemotherapy drug)
or simply stop neoadjuvant therapy and move forward
Primary or first-line therapy
Primary or first-line therapy is just what it sounds like—the
first attempt to get rid of (or control) the cancer in your
body. This can be done with local therapies that target just
the areas where cancer has been found or with systemic
therapies that attack cancer cells throughout the body.
Palliative care is any treatment that relieves your
symptoms and improves your quality of life. It can
include everything from radiation to shrink a painful
tumor, to anti-nausea medication, to talking with a
therapist about handling stress at work.
For years palliative care was thought of as the
treatment of last resort—something that was done
only when everything else had failed. Not anymore.
Today’s clinical guidelines state that palliative
care should be included in every stage of cancer
treatment. Your treatment team should start
evaluating your palliative care needs as soon as
you’re diagnosed, and re-evaluate them regularly as
you move through the treatment process.
A palliative care reality check