Is Cancer Progress Holding us Back?
In 1990, my grandfather was sixty. By those standards, and today’s, he was still a young man. He should have had plenty of life ahead of him. Birthdays to celebrate, weddings to attend, places to see. Unfortunately, a year earlier, he was diagnosed with brain cancer. After a hard fight, he would die in June of that year. I was only six at the time, but I remember feeling sad and wishing I had more time with him. However, I couldn’t understand the concept of cancer. I was barely aware of the concept of death.
As an adult, I know much more about cancer through my work with pharmaceutical and biotechnology companies. As a result, I’m well aware of the amazing progress they – along with academia, health care professionals, caregivers, advocacy groups and patients themselves – have made to extend the lives of cancer patients and alleviate tremendous suffering. And I am positive that had my grandfather been diagnosed in 2013, instead of 1990, much more could have been done to extend his life.
Why am I so confident? Because when it comes to progress in cancer, the evidence is overwhelmingly positive. Here are some highlights:
- A cancer diagnosis used to almost exclusively be a death sentence. Today, according to the National Cancer Institute, nearly half of all cancer patients can expect to live for five or more years after their diagnosis
- Testicular cancer was once immensely difficult to treat. Now, modern therapies can cure 95 percent of men who have the disease
- Drugs that interfere with the action of tyrosine kinase, which enables the spread of lymphoma, can put the disease into remission
- Targeted cancer therapies, part of the future of cancer treatments, can block the growth and spread of cancer by preventing the function of specific molecules that lead to tumor growth and progression. They can impact everything from melanoma to lung and ovarian cancers
Much of this progress has happened in less than 25 years, which in my view is a tremendously small timeframe to have achieved so much in so many distinct types of cancers. Yet for all the progress made, especially when it comes to innovative, efficient drugs, progress may have done more harm than good, based on a frightening report from the Institute of Medicine (IOM), part of the National Academy of Sciences.
The report finds that cancer treatment – with its unlimited, ever-growing body of research and fast-changing guidelines – is so complicated that many U.S. physicians “can’t keep up with new information… are offering incorrect treatment, failing to explain options and leaving patients to coordinate their own care.” The IOM is calling cancer care a “system in crisis” due to growing demand for care, increased diagnoses, and a diminished oncology workforce.
Can it really be that despite amazing advances in science, we haven’t had more success translating science into great patient care? Remember, great patient care extends beyond great treatments, and I’d say the answer is clearly yes, patient care is suffering. The good news? I believe most of the areas where care is falling flat can be fixed through better communication.
Here are a few findings from the report that could be fixed with clear communication:
First: Patients want involvement in their treatment decisions. Over 60% said they want to know the risks associated with their decisions, and 50% said they want to know how much each option will cost them and their families
Physicians shouldn’t have to go it alone. For each cancer and patient, hospitals and treatment centers should work to assign a hospitalist or advocacy group that can dedicate time to a patient and provide a shoulder to lean on for difficult decisions.
Second: A majority (53%) of cancer diagnoses, and 68% of cancer deaths in 2012 were in patients aged 65 and older
The IOM has good suggestions here. Most importantly, coordinated, team-based cancer care can help patients make decisions consistent with their values. What they’ve left out is the need to ensure this information is easily digestible and repeated as much as is needed until patients and their families understand their options.
Third: The IOM projects there will be 18 million cancer survivors by 2022
What I didn’t see in the IOM report are suggestions for long-term psycho-social support. I’ve written about this before, but long-term cancer survivors (70% of patients now live for at least five years after diagnosis) and their caregivers, are about 25% more likely to experience anxiety than those who don’t have cancer. The medical system must adapt and think beyond a cancer cure to continued cancer care. Hospitals, insurance companies and pharmaceutical companies that can partner together to provide this continued care will gain long-lasting trust from both survivors and their families.
I’m confident that we’ll continue making amazing progress in cancer treatments, but we can’t let that progress hinder the overall care that patients receive.