Cancer is the most feared human disease and the second leading cause of death behind heart disease. After starting the War On Cancer, how are we doing in 2015? Is it still only the hype of technology promises, or is there hope in the current panoply of accomplishments from medical research?
To give us answers for how hopeful each of us should feel about progress in cancer care, I reviewed the results presented at the largest international cancer treatment meeting, the American Society of Clinical Oncology in Chicago in June, 2015. How is clinical research doing?
To begin, we must be aware that cancer mortality is continuing to decrease in America! In the past 2 decades, mortality is down 20 percent, an astonishing accomplishment. This is due to earlier diagnosis, but also to improved cancer treatments. This progress against cancer is unprecedented and a direct result of America's investment in the War on Cancer.
In a series of breakthrough research results, speakers at the meeting reported that we can now more effectively harness the power of the body's immune system to control widespread cancer. Just this year, powerful immunotherapy drugs, such as nivolumab and pembrolizumab, have been approved by the FDA for treatments of cancers such as melanoma and lung cancer. In the keynote address at the meeting, Dr. Suzanne Topalian described the outstanding success of years of basic and clinical work in immunotherapy. During the meeting, this type of immune treatment was shown to also have activity against other cancers, including kidney cancer, gastric cancer, breast cancer, liver cancer, bladder cancer, ovarian cancer, head and neck cancer, mesothelioma and Hodgkin's disease. Although we do not yet know how to most effectively combine these treatments can with other types of therapy (surgery, radiation or standard chemotherapy), it is now time for patients to inquire about the possible use of immunotherapy in their own treatments.
Because of the extraordinary accomplishments of the human genome project and application of this gene technology to causes of cancer development and growth (the cancer genome atlas), medicine has developed highly active drugs that "target" the gene changes in some patients' cancers. Prior research demonstrated how targeted therapy with imatinib or similar drugs could improve survival of patients with chronic myelocytic leukemia. Now we know that targeted drugs can also improve the survival of some patients with lung cancer, colon cancer, and breast cancer. Advances described at the meeting emphasized how newer targeted treatments can have dramatic responses in many other cancers including melanoma, leukemia and lymphoma. Appropriate genetic evaluations should be performed in most patients with cancer.
But at the same time, the costs of medical care and cancer care in particular have dramatically escalated. To control these costs, presenters at the meeting discussed the more widespread use of nationally proposed cancer care guidelines which reduce variability in how patients are managed, and the development of novel oncology care models (a result of the Affordable Care Act). Other changes in cancer care delivery will undoubtedly influence where a patient can get care and how much care will be approved by the patient's insurance. Already 33% of oncology practices have been purchased by hospitals or academic institutions. Accountable Care Organizations (ACOs) are proliferating and have contracts with many oncologists and networks which may change the decision process of what cancer care is delivered. Patients will have to ask more questions about what care is planned for them, who will give it to them, and where.
So new therapies really are offering more patients true hope for longer life and cure. So here are my tips about cancer care for you today:
• Don't get cancer! Ask your primary care physician about your own risk of getting cancer (based on your habits and family history of cancer), and how you can reduce your chance of getting cancer by prevention. If your doctor does not know, get a second opinion (see my book Surviving American Medicine about how to get a second opinion).
• Find cancer earlier when it is more curable. Ask you primary care physician about what screening tests you should have (such as mammography, colonoscopy, stool check for blood, PSA testing, CT scan of chest, and skin checkup).
• If a cancer is diagnosed, ask about using robotic surgery instead of standard surgery, and whether newer radiation treatments may be better for you.
• Ask about whether gene testing is appropriate for your cancer, and get a second opinion if the doctor is unsure.
• Ask about targeted therapy or immunotherapy for your cancer. Check if clinical trials of these treatments are available for your cancer.
• Ask your doctor if you are getting care according to national guidelines and what the guidelines are for your illness (Hint: To begin, ask about what the NCCN -- National Comprehensive Cancer Network -- guidelines are for your particular kind of cancer, and then ask how your care is consistent with those guidelines.)
• If you are in a managed care program (HMO, Accountable Care Organization or ACO, new oncology care model, or managed network), ask your doctor if the care plan proposed is the same that the doctor would want for the doctor's own care. If not, ask what else could be done for you.
There is more hope today for cancer patients than ever before. Be sure you are getting all the recent advances that can improve your survival.