This review considers the patterns and likely trends in the use of systemic treatment in the management of cancer. Unlike surgery and radiotherapy, systemic treatments are directed at tumour cells wherever they may be in the body. The importance of systemic therapy is that most cancer deaths are from metastatic, rather than localised, disease.
Systemic treatments have, therefore, the greatest potential to improve cancer outcomes in Scotland.
This will mean more patients with cancer cured of their disease and others living for longer with their cancer. In addition to cytotoxic chemotherapy for patients with advanced disease, systemic treatment includes both endocrine and novel biological agents that may all be used with curative intent in patients with early cancer and even in cancer prevention. More often, however, the treatment of the common adult solid tumours is palliative once they have spread. In these patients, systemic treatment can reduce symptoms, improve quality of life and prolong survival. Adjuvant treatment substantially reduces the risk of recurrence in patients with breast, colorectal, and other cancers.