The trend toward 'de-escalated' cancer treatments, explained
Doctors and patients are embracing fewer aggressive treatments in consideration of quality of life and reduction of side effects


A free daily digest of the biggest news stories of the day - and the best features from our website
Thank you for signing up to TheWeek. You will receive a verification email shortly.
There was a problem. Please refresh the page and try again.
A cancer diagnosis can be terrifying, not just because the disease is life-threatening but also because treatments — chemotherapy, radiation and surgery — are often brutal to endure. But doctors are now rethinking those aggressive methods, The Wall Street Journal reported. They're increasingly looking to "de-escalation," an approach of "cutting back on some therapies to improve a patient's quality of life without hurting their odds of survival."
One new study shows that more than 10,000 rectal cancer patients a year could forgo radiation therapy and do just as well, The New York Times reported, though they would still need chemotherapy and surgery. Dr. Eric Winer, the president of the American Society of Clinical Oncology (ASCO), said researchers "are asking if there are elements of successful treatments that can be eliminated to provide patients with a better quality of life."
What is de-escalation in cancer treatment?
"Fundamentally, studying de-escalation treatment approaches mean that we're evaluating the idea of giving less rather than giving more," wrote Dr. Jyoti Patel at Cancer.Net. Oncologists and patients have been "conditioned to think that more treatment should always be better," but aggressive treatment often comes with side effects that undermine the patient's quality of life. Chemotherapy and radiation can cause hair loss, fatigue and other side effects and induce new forms of cancers.
Subscribe to The Week
Escape your echo chamber. Get the facts behind the news, plus analysis from multiple perspectives.

Sign up for The Week's Free Newsletters
From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.
From our morning news briefing to a weekly Good News Newsletter, get the best of The Week delivered directly to your inbox.
The trend toward de-escalation is partly a recognition of those quality-of-life issues but also a matter of research advances. Thanks to a better understanding of how cancer works, doctors can take a "more nuanced and personalized approach to treatment" instead of throwing everything at the wall. "The goal of cancer therapy has long been about improving survival," Patel wrote, but "we can focus on the quality of life during survival, too."
Where has de-escalation proved promising?
The rectal cancer findings are just the latest in a series of studies on de-escalated therapies. A 2022 study found that some breast cancer patients, for whom treatment typically includes surgery, chemotherapy and radiation treatment, may not need surgery to improve. Testicular cancer patients may also benefit from reduced chemotherapy and radiation treatments, according to results published in November. Another study presented this week at an ASCO conference found laparoscopic surgery worked as well for some pancreatic cancer patients as did more invasive surgical options.
A recent clinical trial found the same rate of "cancer control" in some early-stage cervical cancer patients who received a "simple" hysterectomy (removal of the uterus) as with a radical hysterectomy (removal of the uterus, cervix and surrounding tissue). The findings are likely to be "practice-changing," said Dr. Marie Plante at Laval University in Quebec.
What do patients say?
It's complicated. A survey published in the Journal of Clinical Oncology found that a small group of breast cancer patients were interested in de-escalated therapy for their illness, as long as the word "de-escalation" wasn't used by doctors. It sounded to them like the doctors were giving up on treatment. So instead oncologists speak in terms of "personalized" care. Patients are more inclined to participate in de-escalated treatments, the researchers found, "if they are framed in terms of customizing treatment to the individual patient and added benefit — reduced toxicities, higher quality of life during treatment, and lower risk of long-term complications — rather than in terms of taking treatments away or doing less than the standard of care."
For some slow-moving cancers, though, patients appear to be fine with fewer aggressive treatments. An April study in JAMA Internal Medicine found that 60% of low-risk prostate cancer patients are opting for "advanced surveillance" of their cancer rather than surgery or radiation, up from 16% in 2010. "These data show that a diagnosis of prostate cancer no longer means a patient will undergo treatment," said Dr. Jonathan Shoag of the Seidman Cancer Center in Cleveland. "We now can, and do, avoid treating cancers that we believe will behave indolently."
What's next?
The trend toward de-escalation will continue. Federal regulators this year issued new guidance to cancer drug developers on how to determine dosages, The Wall Street Journal reported. Previously, "doses were traditionally set at the highest tolerable amount." Now those drugmakers are looking for the "best balance between efficacy and safety," said Tara Frenkl, a senior vice president for Bayer. "That's a relatively new concept for oncology."
Continue reading for free
We hope you're enjoying The Week's refreshingly open-minded journalism.
Subscribed to The Week? Register your account with the same email as your subscription.
Sign up to our 10 Things You Need to Know Today newsletter
A free daily digest of the biggest news stories of the day - and the best features from our website
Joel Mathis is a freelance writer who lives in Lawrence, Kansas with his wife and son. He spent nine years as a syndicated columnist, co-writing the RedBlueAmerica column as the liberal half of a point-counterpoint duo. His honors include awards for best online commentary from the Online News Association and (twice) from the City and Regional Magazine Association.
-
Get out and push
Cartoons
By The Week Staff Published
-
'Single people are ignored by politicians'
Instant Opinion Opinion, comment and editorials of the day
By The Week Staff Published
-
Rishi Sunak's tree code: what is the PM's election strategy?
Today's Big Question Conservative leader lining up major policy announcements in bid to rebrand as 'change' candidate
By Elliott Goat Published
-
The 'girl dinner' TikTok trend has dieticians on edge
Speed Read Is it a cute and relatable social media fad or a cover for disordered eating?
By Theara Coleman Published
-
'TikTok brain' may be coming for your kid's attention span
Speed Read What happens to kids' brains when they binge TikTok's endless stream of bite-sized videos?
By Theara Coleman Published
-
Understanding the new Covid-19 variant, Eris
Speed Read The formally named EG.5 is making the rounds, but we don't have to worry just yet
By Devika Rao Published
-
When therapy-speak enters the real world
Speed Read Are you "setting boundaries" or avoiding confrontation?
By Theara Coleman Published
-
The new push to solve long Covid
Speed Read Patients say researchers have been too slow to address the condition
By Joel Mathis Published
-
What is cardiac arrest and why does it happen?
Speed Read The heart condition impacts younger athletes more often than expected
By Devika Rao Published
-
What is medical identity theft and how can you avoid it?
The Explainer Scammers can often target medical insurance as part of their grift
By Justin Klawans Published
-
The problem with self-diagnosing
Speed Read Teens are turning to social media to diagnose themselves with mental health conditions
By Devika Rao Published