Therapy (often abbreviated tx or Tx) is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is usually synonymous with treatment (also abbreviated tx).
Among psychologists and other mental health professionals, including psychiatrists, psychiatric nurse practitioners, and clinical social workers, the term may refer specifically to psychotherapy (sometimes dubbed ‘talking therapy’). The English word therapy comes via Latin therapīa from Greek: θεραπεία and literally means “curing” or “healing”.
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 called 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).
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.
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.
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.