Attempted medical remediation of a health problem
A
therapy
or
medical treatment
is the attempted remediation of a
health
problem, usually following a
medical diagnosis
. Both words,
treatment
and
therapy
, are often abbreviated
tx
,
Tx
, or
T
x
.
As a rule, each therapy has
indications
and
contraindications
. There are many different types of therapy. Not all therapies are
effective
. Many therapies can produce unwanted
adverse effects
.
Treatment
and
therapy
are often synonymous, especially in the usage of
health professionals
. However, in the context of
mental health
, the term
therapy
may refer specifically to
psychotherapy
.
Semantic field
[
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]
The words
care
,
therapy
,
treatment
, and
intervention
overlap in a
semantic field
, and thus they can be
synonymous
depending on
context
. Moving rightward through that order, the
connotative
level of
holism
decreases and the level of specificity (to
concrete
instances) increases. Thus, in
health-care
contexts (where its
senses
are always
noncount
), the word
care
tends to imply a broad idea of everything done to protect or improve someone's health (for example, as in the terms
preventive care
and
primary care
, which connote ongoing action), although it sometimes implies a narrower idea (for example, in the simplest cases of
wound care
or
postanesthesia care
, a few particular steps are sufficient, and the patient's interaction with the provider of such care is soon finished). In contrast, the word
intervention
tends to be specific and concrete, and thus the word is often
countable
; for example, one instance of
cardiac catheterization
is one
intervention
performed, and
coronary care
(noncount) can require a series of interventions (count). At the extreme, the piling on of such countable interventions amounts to
interventionism
, a flawed model of care lacking holistic
circumspection
?merely treating
discrete
problems (in billable increments) rather than maintaining health.
Therapy
and
treatment
, in the middle of the semantic field, can connote either the holism of
care
or the discreteness of
intervention
, with context conveying the intent in each use. Accordingly, they can be used in both noncount and count senses (for example,
therapy for
chronic kidney disease
can involve several
dialysis
treatments per week
).
The words
aceology
and
iamatology
are obscure and obsolete synonyms referring to the study of therapies.
The English word
therapy
comes via Latin
therap?a
from
Greek
:
θεραπε?α
and literally means "curing" or "healing".
[1]
The term
therapeusis
is a somewhat archaic doublet of the word
therapy
.
Types of therapies
[
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]
By chronology, priority, or intensity
[
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]
Levels of care
[
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]
Levels of care classify
health care
into categories of chronology, priority, or intensity, as follows:
- Urgent care
handles health issues that need to be handled today but are not necessarily emergencies; the urgent care venue can send a patient to the emergency care level if it turns out to be needed.
- In the United States (and possibly various other countries),
urgent care
centers also serve another function as their other main purpose: U.S.
primary care
practices have evolved in recent decades into a configuration whereby urgent care centers provide portions of primary care that cannot wait a month, because getting an appointment with the primary care practitioner is often subject to a waitlist of 2 to 8 weeks.
- Emergency care
handles
medical emergencies
and is a first point of contact or intake for less serious problems, which can be referred to other levels of care as appropriate.
- Intensive care
, also called
critical care
, is care for extremely ill or injured patients. It thus requires high resource intensity, knowledge, and skill, as well as quick
decision making
.
- Ambulatory care
is care provided on an
outpatient
basis. Typically patients can walk into and out of the clinic under their own power (hence "ambulatory"), usually on the same day.
- Home care
is care at home, including care from providers (such as physicians, nurses, and home health aides) making
house calls
, care from
caregivers
such as family members, and patient
self-care
.
- Primary care
is meant to be the main kind of care in general, and ideally a
medical home
that unifies care across referred providers.
- Secondary care
is care provided by medical specialists and other health professionals who generally do not have first contact with patients, for example,
cardiologists
,
urologists
and
dermatologists
. A patient reaches secondary care as a next step from
primary care
, typically by provider referral although sometimes by patient self-initiative.
- Tertiary care
is specialized consultative care, usually for
inpatients
and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a
tertiary referral hospital
.
- Follow-up care is additional care during or after
convalescence
. Aftercare is generally synonymous with follow-up care.
- End-of-life care
is care near the end of one's life. It often includes the following:
- Palliative care
is
supportive care
, most especially (but not necessarily) near the end of life.
- Hospice
care is palliative care very near the end of life when
cure
is very unlikely. Its main goal is comfort, both physical and mental.
Lines of therapy
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]
Treatment decisions often follow formal or informal
algorithmic
guidelines. Treatment options can often be ranked or prioritized into
lines of therapy
:
first-line therapy
,
second-line therapy
,
third-line therapy
, and so on.
First-line therapy
(sometimes referred to as
induction therapy
,
primary therapy
, or
front-line therapy
)
[2]
is the first therapy that will be tried. Its priority over other options is usually either: (1) formally recommended on the basis of
clinical trial
evidence for its best-available combination of efficacy, safety, and tolerability or (2) chosen based on the clinical experience of the physician. If a first-line therapy either fails to resolve the issue or produces intolerable
side effects
, additional (second-line) therapies may be substituted or added to the treatment regimen, followed by third-line therapies, and so on.
An example of a context in which the formalization of treatment algorithms and the ranking of lines of therapy is very extensive is
chemotherapy regimens
. Because of the great difficulty in successfully treating some forms of cancer, one line after another may be tried. In
oncology
the count of therapy lines may reach 10 or even 20.
Often multiple therapies may be tried simultaneously (
combination therapy
or polytherapy). Thus
combination chemotherapy
is also called polychemotherapy, whereas chemotherapy with one agent at a time is called single-agent therapy or monotherapy.
Adjuvant therapy
is therapy given in addition to the primary, main, or initial treatment, but simultaneously (as opposed to second-line therapy).
Neoadjuvant therapy
is therapy that is begun before the main therapy. Thus one can consider surgical excision of a tumor as the first-line therapy for a certain type and stage of cancer even though radiotherapy is used before it; the radiotherapy is neoadjuvant (chronologically first but not primary in the sense of the main event).
Premedication
is conceptually not far from this, but the words are not interchangeable; cytotoxic drugs to put a tumor "on the ropes" before surgery delivers the "knockout punch" are called neoadjuvant chemotherapy, not premedication, whereas things like anesthetics or prophylactic antibiotics before dental surgery are called premedication.
Step therapy
or stepladder therapy is a specific type of prioritization by lines of therapy. It is controversial in
American health care
because unlike conventional
decision-making
about what constitutes first-line, second-line, and third-line therapy, which in the U.S. reflects safety and efficacy first and cost only according to the patient's wishes, step therapy attempts to mix cost containment by someone other than the patient (third-party payers) into the algorithm.
Therapy freedom
and the negotiation between
individual and group rights
are involved.
[
citation needed
]
By intent
[
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]
Therapy type
|
Description
|
abortive therapy
|
A therapy that is intended to stop a medical condition from progressing any further. A medication taken at the earliest signs of a disease, such as an
analgesic
taken at the first symptoms of a
migraine headache
to prevent it from getting worse, is an abortive therapy. Compare
abortifacients
, which abort a pregnancy.
|
bridge therapy
|
A therapy that
figuratively
provides a bridge to another step or phase, crossing over some immediate chasm (challenge), in contrast with
destination therapy
, which is the final therapy in cases where clinically appropriate.
|
consolidation therapy
|
A therapy given to consolidate the gains from
induction therapy
. In cancer, this means chasing after any malignant cells that may be left.
|
curative therapy
|
A therapy with
curative intent
, that is, one that seeks to
cure
the root cause of a disorder. (also called etiotropic therapy)
|
definitive therapy
|
A therapy that may be final, superior to others,
curative
, or all of those.
|
destination therapy
|
A therapy that is the final destination rather than a
bridge
to another therapy. Usually refers to
ventricular assist devices
to keep the existing heart going, not just until
heart transplantation
can occur, but for the rest of the patient's life expectancy.
|
empiric therapy
|
A therapy given on an empiric basis; that is, one given according to a clinician's educated guess despite uncertainty about the illness's causative factors. For example, empiric antibiotic therapy administers a
broad-spectrum antibiotic
immediately on the basis of a good chance (given the history, physical examination findings, and risk factors present) that the illness is bacterial and will respond to that drug (even though the bacterial species or variant is not yet known).
|
gold standard therapy
|
A therapy that is
definitive
, just as a
gold standard diagnostic test
is a definitive test.
|
investigational therapy
|
An
experimental
therapy. Use of experimental therapies must be ethically justified, because by definition they raise the question of
standard of care
. Physicians have autonomy to provide empirical care (such as
off-label
care) according to their experience and clinical judgment, but the autonomy has limits that preclude
quackery
. Thus it may be necessary to design a
clinical trial
around the new therapy and to use the therapy only per a formal
protocol
. Sometimes shorthand phrases such as "treated on protocol" imply not just "treated according to a plan" but specifically "treated with investigational therapy".
|
maintenance therapy
|
A therapy taken during
disease remission
to prevent relapse.
|
palliative therapy
|
See
supportive therapy
for connotative distinctions.
|
preventive therapy
(prophylactic therapy)
|
A therapy that is intended to
prevent a medical condition
from occurring (also called prophylaxis). For example, many
vaccines
prevent infectious diseases.
|
salvage therapy
(rescue therapy)
|
A therapy tried after others have failed; it may be a "last-
line
" therapy.
|
stepdown therapy
|
Therapy that tapers the dosage gradually rather than abruptly cutting it off. For example, a switch from intravenous to oral antibiotics as an infection is brought under control steps down the intensity of therapy.
|
supportive therapy
|
A therapy that does not treat or improve the underlying condition, but rather increases the patient's comfort, also called
symptomatic treatment
(see there for more information).
[3]
For example, supportive care for flu, colds, or gastrointestinal upset can include rest, fluids, and
over-the-counter
pain relievers; those things do not treat the cause, but they treat the symptoms and thus provide relief. Supportive therapy may be palliative therapy (
palliative care
). The two terms are sometimes synonymous, but palliative care often specifically refers to serious illness and
end-of-life care
. Therapy may be categorized as having
curative intent
(when it is possible to eliminate the disease) or
palliative intent
(when eliminating the disease is impossible and the focus shifts to minimizing the distress that it causes). The two are often
contradistinguished
(mutually exclusive) in some contexts (such as the
management of some cancers
), but they are not inherently mutually exclusive; often therapy can be both curative and palliative simultaneously.
Supportive psychotherapy
aims to support the patient by alleviating the worst of the symptoms, with the expectation that
definitive therapy
can follow later if possible.
|
systemic therapy
|
A therapy that is
systemic
. In the physiological
sense
, this means affecting the whole body (rather than being local or locoregional), whether via
systemic administration
, systemic effect, or both.
Systemic therapy in the psychotherapeutic sense
seeks to address people not only on the individual level but also as people in relationships, dealing with the interactions of groups.
|
By therapy composition
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]
Treatments can be classified according to the method of treatment:
By procedure and human interaction
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]
By animal interaction
[
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]
See also
[
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]
References
[
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]
- ^
Online Etymology Dictionary,
Therapy
- ^
National Cancer Institute > Dictionary of Cancer Terms > first-line therapy
Retrieved July 2010
- ^
"CFIDS"
. CFIDS. Archived from
the original
on 2012-02-13
. Retrieved
2012-01-09
.
- ^
Schwartz, Jeremy.
"5 Reasons to Consider Group Therapy"
.
U.S. News & World Report
.
Archived
from the original on 22 July 2017
. Retrieved
12 April
2021
.
- ^
Shorter, Edward (January 1996). "The beginning of psychopharmacology: Deep-sleep therapies".
European Psychiatry
.
11
: 236s.
doi
:
10.1016/0924-9338(96)88707-4
.
S2CID
144323687
.
- ^
Minkel, Jared D.; Krystal, Andrew D.; Benca, Ruth M. (2017).
"Unipolar Major Depression"
. In Kryger, Meir; Roth, Thomas; Dement, William C. (eds.).
Principles and Practice of Sleep Medicine
(6th ed.). Philadelphia, PA: Elsevier. pp. 1352?1362.
ISBN
978-0-323-24288-2
. Retrieved
12 May
2021
.
External links
[
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]