When it comes to our health and our health care, we love the numbers. Sometimes, we even fall in love with the numbers, assuming that the numbers tell us the whole story when in fact that may not be the case. Cholesterol numbers, blood pressure numbers, body mass index, whatever. As patients and consumers, we are frequently defined by our numbers.
But what happens when those numbers and other medical tests such as CT scans really don’t tell the story we think they do? The recent evolution of prostate specific antigen (PSA) is a case in point: for decades we believed the numbers saved many lives. Turns out PSA did save some lives, but not as many as we thought and at the considerable financial and human expense of treating many men who probably did not benefit.
So in that vein an article and editorial in a recent issue of the Journal of Clinical Oncology makes the point that just because we have numbers does not really mean they offer us the scientific certainty about the course of cancer we may think they do.… Continue reading →
Perhaps more than most, doctors struggle with memories that mark sad moments in their careers. For me, one of the most indelible was about a wonderful young man with chronic myeloid leukemia (CML).
When I started my oncology career in the early 1970’s, CML was almost always fatal. It would start with a chronic phase which was treated with pretty simple medications. But those medications didn’t cure the disease.
The “almost always” scenario with CML was that several years on, it would morph into an acute phase, or “blast crisis,” that almost always ended in an untimely and frequently very premature death.
I came into contact with this young man just as he was diagnosed with CML. A couple of years later, he entered that acute phase. Rather than face the rigors of intensive chemotherapy, a regimen that was almost always futile, he took his own life. Moments like that live with us forever.
Decades later, (2003 to be exact) a prominent oncologist—who at the time was the director of the National Cancer Institute—made an audacious promise. Andrew von Eschenbach said that by 2015 we would end the suffering and death from cancer and convert it to a chronic … Continue reading →
Cancer Moonshot Summit.
Who would have imagined five short months ago that on this special day, almost 300 cancer centers and programs in every state attended by over 6000 leaders in cancer care and research, patients, advocates, and many others would have come together to commit themselves to doing what needs to be done—by everyone—to make this cancer’s last century?
Yet that is exactly what happened. President Obama made the declaration in his recent State of the Union address, put Vice President Biden in charge, and there has been no looking back. It is truly an amazing day in the annals of cancer care.
I was honored to be part of the program at the MD Anderson Cancer Center, hosted by the Center’s President Ronald DePinho MD. We were joined by hundreds of participants for two and one half hours of discussions focused on what all of us can do to move this effort forward. And among the speakers was Houston Texans’ defensive end, Devon Still, who shared with a hushed audience about his young daughter’s journey with neuroblastoma—and challenged all of us to reach out to communities to increase awareness about prevention, early detection and … Continue reading →
Right now, when we want to know everything we can about a tumor, we do surgery: a biopsy to take a sample of it and look at it under a microscope and determine as best we can how to treat it. But what if instead you could get a blood test, and learn even more. That’s the promise of the relatively new science of what is called cell free DNA (cfDNA). It holds the hope of helping us better understand cancer, its behavior in our bodies over time, and even offering clues on how to better treat cancer in ways we would never have imagined even a few short years ago.
It was an important area of discussion at the American Society of Clinical Oncology meeting this week. It’s a meeting where, every year, we get a sense of the future of cancer treatment before it becomes a reality. From genomics, to immunotherapy, to targeted therapies–you name it—promising areas appear on the scene, then either become part of our reality or lose luster as the process unfolds over the course of several ASCO annual meetings. This year, several studies presented on the topic of the so-called “liquid biopsy” illustrate how … Continue reading →
Here at the annual meeting of the American Society of Clinical Oncology in Chicago, we see results of eagerly awaited clinical trials that have involved hundreds or even thousands of patients, millions of dollars, and years of hard work and analysis. The results can be a success; they may fail; but quite often fall somewhere in between. And even when successful, the results may not be as clear cut as one would like.
Such is the case with an important trial whose results came were reported at this meeting and simultaneously published in the New England Journal of Medicine about the use of aromatase inhibitors (AI) in post-menopausal women with breast cancer. As is so often the case, the researchers are highly regarded, the study well designed—but even with all the best efforts possible, left open are some extremely difficult questions.… Continue reading →
Here at the at annual meeting of the American Society of Clinical Oncology in Chicago, we are beginning to see the future of cancer therapy—and it raises a provocative question: will precision medicine become so precise, we risk turning off the much-needed investment of human, intellectual and financial capital that keeps progress flowing?
The sheer number of new drugs and new combinations of drugs being reported here at the world’s biggest, and most relevant cancer conference is staggering. Not all of them are ready for prime time, and some may never be successful in the clinic for large numbers of patients, but it is clear the era of old fashioned chemotherapy is diminishing and newer forms of therapies (targeted and immunotherapies among others) are on the rapid ascent.
But with progress, it’s becoming clear that a changing paradigm in cancer care that was predicted a number of years ago is now coming to life.… Continue reading →
The largest and most important cancer meeting of the year, the American Society of Clinical Oncology Annual Meeting, is going on this weekend in Chicago, and that’s a good time for one to give some thought to the broader topic of what has happened in cancer care over the past year.
But as I have started sitting in the sessions listening to stories of progress and new breaking research on truly innovative therapeutics and diagnostics, a lingering, somewhat troubling thought has persisted. I find myself coming back to a very basic question: we are spending billions—yes, billions—on new approaches to detecting and treating cancer. But we are spending nowhere near that amount on the fundamental “blocking and tackling” in cancer: the tactics that can help prevent the disease and –by applying what we know—can reduce its deadly toll.
What has been on my mind is a chance meeting I had with a lady during my recent travels. She saw the American Cancer Society lapel pin that I wear on my suit jacket and asked me if we are making progress in treating cancer. I answered her question with my usual cautious optimism (for some diseases, significant progress; for others, … Continue reading →
Change is a good thing, a necessary thing. At the same time, I have to ask how many realize how much change is happening so quickly in oncology and cancer care? And I wonder even more how we are going to separate change that is valuable from change that is simply, well, for the sake of change.
What brought about this moment of reflection was my attendance at a conference this past week sponsored by the American Cancer Society Cancer Action Network focused on the future of health care. The specific topic was “The Role of Technology in America’s Shifting Health Care Landscape.”
After spending a day listening to discussions of change in cancer care—led primarily by emerging data analytics and health information technology—I was struck how the cancer landscape might be shifting quickly in ways that many of us don’t understand, and in fact can’t fathom. Putting the pieces of this puzzle together in a rational way in my opinion is beyond the capabilities of many of us, even those who have devoted our lives to understanding cancer.… Continue reading →
Cancer drugs—especially the new targeted and immunotherapies—are very, very expensive.
No doubt about that, and there is also no lack of effort trying to cast blame on who bears responsibility for those costs. There is even a recent article in the British Medical Journal that analyzes the size of the vials those drugs come in and suggests for some companies at least that may be a strategy to increase costs even further. What most experts can agree on is that this is a complicated problem for which there are no easy solutions.
I recently wrote a short commentary on the issue which appeared in Healio’s “HemOnc Today.” Although not exhaustive in terms of analyzing the issue, it does point out that we need to find a balance that continues to provide the incentive to innovate and bring new treatments to the care of cancer patients, while maintaining some degree of restraint given the reality that these costs simply cannot continue to increase without limit.… Continue reading →
A full waiting room. To most of us, it’s a bad sign, as we anticipate the excruciatingly dull minutes ahead. But at a meeting I attended this past week, it was a sign of hope, of progress; of making a difference.
I was in Washington DC to attend the annual scientific session of the Melanoma Research Alliance (MRA) in Washington DC, an organization that is only eight years old. When this group first met, it was made up of a relative handful of melanoma researchers and clinicians who came together to figure out what they could do to discover and promote more research and better treatment options for patients with melanoma.
The people behind the effort were Michael Milken and Debra and Leon Black. For them the mission was personal: Mr. Milken was a prostate cancer survivor who wanted to devote his energies to accelerating discoveries in cancer care. The Blacks are also well known in financial circles, and Ms. Black was (and remains) a melanoma survivor.
At the time, the landscape for patients with advanced melanoma was bleak. There were a couple of available treatments, but they really didn’t have much of an impact on improving or extending … Continue reading →