`No progress in cancer care? Really?

`No progress in cancer care? Really?

That’s the question I am struggling with following an interview I did with a radio network last week, and which will likely be released a couple of weeks from now. I was asked to respond to the premise offered by a book author who is a well-known professor at a major academic medical center, exclaiming that our treatment for cancer is based on “Slash, burn and poison” and that our cancer research efforts are currently substantially misdirected.

Instead, the professor says, we should admit that we have not made meaningful progress in treating cancer, and that our research is too directed to the end of the cancer cycle (namely a couple of months improvement in life expectancy for those with cancer) and in fact should be focused on the “first cell.”

It’s a refrain I have heard before, as early as my beginning engagement in treating patients with cancer in the 1970s. “Slash, burn and poison”—or similar words—were legion at that time. Surgery, radiation and chemotherapy were toxic, had substantial side effects, often ineffective and not offering much hope beyond a small number of cancers such as Hodgkin Disease which was showing excellent responses to radiation and chemotherapy.

From my perspective, how things have changed. Yes, there are still several cancers that respond poorly to treatment such as pancreatic cancer and advanced sarcoma among others. And, yes, the side effects of treatment are not inconsequential—although our awareness of those side effects and our ability to treat them are more robust today than they were in the past. And far too many people succumb to their disease. We ignore those realities at our own peril.

Here is the reality: we reduced cancer mortality by 27% between 1991, when cancer mortality rates peaked, and 2016. Rates of deaths from breast cancer have declined 40% over a similar time frame. Deaths from advanced melanoma have declined around 5% a year from 2012-2016, and that’s a disease where we literally had nothing to offer that was meaningful in 2010.

The Society estimates that translates to 2.7 million fewer cancer deaths in that time thanks to increased public awareness, better screening, vaccines to prevent some cancers, earlier detection, and more effective treatments. The Society also estimates that there are now around 17 million cancer survivors in the United States today.  Targeted therapies and immunotherapies continue to broaden the landscape of effective cancer treatment, producing some remarkable (and, frankly, unanticipated) results. Our understanding of the genetics of cancer cells and the functional components of the cancer cell are increasing essentially daily.

We must never accept that we have solved the problem of cancer, and we must always be open to new ideas.  The American Cancer Society is especially proud of its many decades of funding young cancer researchers with bright ideas and providing early funding to 49 researchers that went on the win the Nobel Prize—and many other researchers who have led distinguished careers making innumerable contributions to our understanding of cancer, impacting people every day.

And we must never forget that we still lose too many to the scourge of cancer, and that we could do much, much better in so many areas:

  • We need to continue to reduce combustible tobacco consumption, which has an extraordinary impact on the burden and suffering from cancer.
  • We need to get young people vaccinated against HPV. We can reduce the incidence of cervical cancers (and others) to a negligible level.
  • We can effectively screen for breast, colorectal, cervical and lung cancer which would have a substantial impact on reducing deaths from cancer.
  • We could reduce the barriers to effective cancer care among disadvantaged and rural populations, among others, creating an environment of true health equity.
  • We could increase funding for cancer research, especially for those new ideas that spark success (which can literally take decades to achieve).

And this is only a very limited partial list.

By the way, the solution the professor offers is “to focus on the first cell.” What isn’t noted is that cancer research has long been focused on that first cell, trying to understand what makes a cell a cancer cell, how our bodies deal effectively with many of those errant cells, why some escape and proliferate, and why some become lethal cancers and others do not. In fact, billions of dollars—from private and public companies, and non-profit organizations like the American Cancer Society and others—are focused on finding the signals from those very “first cells”, and hopefully improving the odds of detection and more effective treatments earlier in the course of the disease.

If we have in fact not made much progress in treating cancer over the past fifty years and our research investment has not produced gains, would it be intemperate of me to ask who would be comfortable rolling back the clock and not include any of those advances in the care of our patients today?

Yes, as I mentioned previously, there are some notable areas where progress has not been forthcoming. But that doesn’t mean we haven’t made progress. However, that does not negate the fact that millions—yes, millions—of people are alive today as a result of what has been accomplished.

I learned a long time ago is never to take anything for granted. Progress is slower than any of us would like. 20 years ago I was asking the same question: where is the progress? Today, I no longer struggle with the answer. What I struggle with is how we continue our investment, and how we make the progress and knowledge we have achieved available to everyone.

Yes, the first cell is important. It is today, has been for decades, and will be for decades more. We could substantially reduce the burden of suffering from cancer today if we could do for everyone what we already know works and if we as a nation made a commitment to health.  And we will continue to seek every opportunity—day after day after day—to make cancer a story for the history books.

However, let us not forget the progress we have made. It is real, it is palpable, and it is not to be trivialized as a throw-away line designed to sell books.

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