Second-line Treatment

A therapy or medical treatment (often abbreviated tx, Tx, or T_x) is the attempted remediation of a health problem, usually following a medical diagnosis.

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.

''Medical treatment'' and ''therapy'' are generally considered synonyms. However, in the context of mental health, the term ''therapy'' may refer specifically to psychotherapy.

History

Before the creating of therapy as a formal procedure, people told stories to one another to inform and assist about the world. The term "healing through words" was used over 3,500 years ago in Greek and Egyptian writing. The term psychotherapy was invented in the 19th century, and psychoanalysis was founded by Sigmund Freud under a decade later.

Semantic field

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 that provider 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 ''therapīa'' from grc-gre, θεραπεία and literally means "curing" or "healing".

Types of therapies

Therapy comes in different forms. These include, cognitive behavioral therapy, dialectical behavior therapy, mindful based cognitive therapy, physical therapy, etc. Therapists are here for use and used daily by many people. Therapist are trained to provide treatment to an individual or group. Therapy was invented in the 1800s and the founder was Franz Mesmer, the "Father of Western Psychotherapy". Sigmund Freud then comes into play and shows us the understanding depth of all the different types included in therapy. Therapy is used in many ways to shape and help reform a person. This type of treatment allows individuals to regain gain goals lost or wanting to accomplish. Many individuals come into therapy looking for ways to cope with issues and to receive an emotional release. For example, healing from trauma, in need of support, emotional issues, and many more. Allowing yourself to express your thoughts and feelings go a long way in therapy recovery, this is called the therapeutic process.

By chronology, priority, or intensity

Levels of care

Levels of care classify health care into categories of chronology, priority, or intensity, as follows:
* 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

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) 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.

By intent

By therapy composition

Treatments can be classified according to the method of treatment:

By

matter

* by drugs: pharmacotherapy, chemotherapy (also, ''medical therapy'' often means specifically pharmacotherapy)
* by medical devices: implantation
** cardiac resynchronization therapy
* by specific molecules: molecular therapy (although most drugs are specific molecules, ''molecular medicine'' refers in particular to medicine relying on molecular biology)
** by specific biomolecular targets: targeted therapy
*** molecular chaperone therapy
** by chelation: chelation therapy
* by specific chemical elements:
** by metals:
*** by heavy metals:
**** by gold: chrysotherapy (aurotherapy)
**** by platinum-containing drugs: platin therapy
*** by biometals
**** by lithium: lithium therapy
**** by potassium: potassium supplementation
**** by magnesium: magnesium supplementation
**** by chromium: chromium supplementation; phonemic neurological hypochromium therapy
**** by copper: copper supplementation
** by nonmetals:
*** by diatomic oxygen: oxygen therapy, hyperbaric oxygen therapy (hyperbaric medicine)
**** transdermal continuous oxygen therapy
*** by triatomic oxygen (ozone): ozone therapy
*** by fluoride: fluoride therapy
*** by other gases: medical gas therapy
* by water:
** hydrotherapy
** aquatic therapy
** rehydration therapy
*** oral rehydration therapy
** water cure (therapy)
* by biological materials (biogenic substances, biomolecules, biotic materials, natural products), including their synthetic equivalents: biotherapy
** by whole organisms
*** by viruses: virotherapy
*** by bacteriophages: phage therapy
*** by animal interaction: ''see animal interaction section''
** by constituents or products of organisms
*** by plant parts or extracts (but many drugs are derived from plants, even when the term ''phytotherapy'' is not used)
**** scientific type: phytotherapy
**** traditional (prescientific) type: herbalism
*** by animal parts: quackery involving shark fins, tiger parts, and so on, often driving threat or endangerment of species
*** by genes: gene therapy
**** gene therapy for epilepsy
**** gene therapy for osteoarthritis
**** gene therapy for color blindness
**** gene therapy of the human retina
**** gene therapy in Parkinson's disease
*** by epigenetics: epigenetic therapy
*** by proteins: protein therapy (but many drugs are proteins despite not being called protein therapy)
*** by enzymes: enzyme replacement therapy
*** by hormones: hormone therapy
**** hormonal therapy (oncology)
**** hormone replacement therapy
***** estrogen replacement therapy
***** androgen replacement therapy
***** hormone replacement therapy (menopause)
***** transgender hormone therapy
****** feminizing hormone therapy
****** masculinizing hormone therapy
**** antihormone therapy
***** androgen deprivation therapy
*** by whole cells: cell therapy (cytotherapy)
**** by stem cells: stem cell therapy
**** by immune cells: ''see immune system products below''
*** by immune system products: immunotherapy, host modulatory therapy
**** by immune cells:
***** T-cell vaccination
***** cell transfer therapy
***** autologous immune enhancement therapy
***** TK cell therapy
**** by humoral immune factors: antibody therapy
***** by whole serum: serotherapy, including antiserum therapy
***** by immunoglobulins: immunoglobulin therapy
****** by monoclonal antibodies: monoclonal antibody therapy
** by urine: urine therapy (some scientific forms; many prescientific or pseudoscientific forms)
** by food and dietary choices:
*** medical nutrition therapy
*** grape therapy (quackery)
* by salts (but many drugs are the salts of organic acids, even when drug therapy is not called by names reflecting that)
** by salts in the air
*** by natural dry salt air: "taking the cure" in desert locales (especially common in prescientific medicine; for example, one 19th-century way to treat tuberculosis)
*** by artificial dry salt air:
**** low-humidity forms of speleotherapy
**** negative air ionization therapy
*** by moist salt air:
**** by natural moist salt air: seaside cure (especially common in prescientific medicine)
**** by artificial moist salt air: water vapor forms of speleotherapy
** by salts in the water
*** by mineral water: spa cure ("taking the waters") (especially common in prescientific medicine)
*** by seawater: seaside cure (especially common in prescientific medicine)
* by aroma: aromatherapy
* by other materials with mechanism of action unknown
** by occlusion with duct tape: duct tape occlusion therapy

By

energy

* by electric energy as electric current: electrotherapy, electroconvulsive therapy
** Transcranial magnetic stimulation
** Vagus nerve stimulation
* by magnetic energy:
** magnet therapy
** pulsed electromagnetic field therapy
** magnetic resonance therapy
* by electromagnetic radiation (EMR):
** by light: light therapy (phototherapy)
*** ultraviolet light therapy
**** PUVA therapy
*** photodynamic therapy
**** photothermal therapy
**** cytoluminescent therapy
*** blood irradiation therapy
*** by darkness: dark therapy
*** by lasers: laser therapy
**** low level laser therapy
** by gamma rays: radiosurgery
*** radiosurgery#Gamma Knife, Gamma Knife radiosurgery
*** stereotactic radiation therapy
*** cobalt therapy
** by radiation generally: radiation therapy (radiotherapy)
*** intraoperative radiation therapy
*** by EMR particles:
**** particle therapy
***** proton therapy
***** electron therapy
****** intraoperative electron radiation therapy
****** Auger therapy
***** neutron therapy
****** fast neutron therapy
****** neutron capture therapy of cancer
*** by radioisotopes emitting EMR:
**** by nuclear medicine
**** by brachytherapy
** quackery type: electromagnetic therapy (alternative medicine)
* by Mechanics, mechanical: manual therapy as massotherapy and therapy by exercise as in physical therapy
** inversion therapy
* by sound:
** by ultrasound:
*** ultrasonic lithotripsy
**** extracorporeal shockwave therapy
*** sonodynamic therapy
** by music: music therapy
* by temperature
** by heat: heat therapy (thermotherapy)
*** by moderately elevated ambient temperatures: hyperthermia therapy
**** by dry warm surroundings: Waon therapy
**** by dry or humid warm surroundings: sauna, including infrared sauna, for sweat therapy
** by cold:
*** by extreme cold to specific tissue volumes: cryotherapy
*** by ice and compression: cold compression therapy
*** by ambient cold: hypothermia therapy for neonatal encephalopathy
** by hot and cold alternation: contrast bath therapy

By procedure and human interaction

* Surgery
* by counseling, such as psychotherapy (''see also: list of psychotherapies'')
** systemic therapy
** by group psychotherapy
* by cognitive behavioral therapy
** by cognitive therapy
** by behaviour therapy
*** by dialectical behavior therapy
** by cognitive emotional behavioral therapy
* by cognitive rehabilitation therapy
* by family therapy
* by education
** by psychoeducation
** by information therapy
* by speech therapy, physical therapy, occupational therapy, vision therapy, massage therapy, chiropractic or acupuncture
* by Lifestyle medicine, lifestyle modifications, such as avoiding Junk food, unhealthy food or maintaining a predictable sleep schedule
* by coaching

By animal interaction

* by pets, assistance animals, or working animals: animal-assisted therapy
** by horses: equine therapy, hippotherapy
** by dogs: pet therapy with therapy dogs, including grief therapy dogs
** by cats: pet therapy with therapy cats
* by fish: ichthyotherapy (wading with fish), aquarium therapy (watching fish)
* by maggots: maggot therapy
* by worms:
** by internal worms: helminthic therapy
** by leeches: leech therapy
* by immersion therapy, immersion: animal bath

By meditation

* by mindfulness: mindfulness-based cognitive therapy

By reading (process), reading

* by bibliotherapy

By creativity

* by expression: expressive therapy
** by writing: writing therapy
*** journal therapy
* by play (activity), play: play therapy
* by art: art therapy
** sensory art therapy
** comic book therapy
* by gardening: horticultural therapy
* by dance: dance therapy
* by drama: drama therapy
* by recreation: recreational therapy
* by music: music therapy

By sleeping and waking

* by deep sleep: deep sleep therapy
* by sleep deprivation: wake therapy

See also

* Biophilia hypothesis
* Classification of Pharmaco-Therapeutic Referrals
* Cure
* Interventionism (medicine)
* Inverse benefit law
* List of therapies
* Greyhound therapy
* Mature minor doctrine
* Medicine
* Medication
* Nutraceutical
* Prevention (medical), Prevention
* Psychotherapy
* Treatment as prevention
* Therapeutic inertia
* Therapeutic nihilism, the idea that treatment is useless

References

External links

*
*

"Chapter Nine of the Book of Medicine Dedicated to Mansur, with the Commentary of Sillanus de Nigris"
is a Latin book by Rhazes, from 1483, that is known for its ninth chapter, which is about therapeutics

{{Authority control

Therapy,
Drug discovery
Health policy
Medicinal chemistry
Pharmaceutical sciences