June 15, 2015

Cancer Care at a Crossroads

Mary MahoneyBY Mary Mahoney

J. Robinson Group Blog

Promising new drugs, innovative techniques and improved survival rates are intersecting with a rise in cancer cases, skyrocketing costs and skeptical patients. So, how do we improve our odds?

It doesn’t hurt to do a little research. For instance, a search into treatments for metastasized cancer – cancer that has spread to different organs—yields an interesting theory that upends conventional practice. Healthline reported that the approach involves treating the metastases first, leaving the primary tumor to be removed later.

“There are some patients, when faced with the diagnosis, their first response is, ‘Get it out,’” said George Chang, a colorectal oncology surgeon who co-authored the original study in JAMA Surgery. “If the primary colorectal tumors aren’t causing bleeding or digestive blockages, they aren’t responsible for a patient’s death. Death from Stage 4 colorectal cancer happens when the cancer spreads to the liver or lungs.”

Waiting to remove the primary tumors postpones a surgery with potential complications and weeks of recovery. Addressing the other sites first, with chemotherapy, treats the more dangerous tumors faster.

Another oncologist, Mark Welton, said in the same article that different and more powerful drugs, like Avastin, have made these changes possible, but most people are unaware of the shift. “Chemotherapy first has become the standard approach at major cancer centers,” he said. “But it takes a long time for what’s known in specialty centers to disseminate out to the average population.”

Indeed, in 2014, 10 new cancer medications were introduced, according to The State of Cancer in America: 2015. The report goes on to say that last year a record 14.5 million survived the diseases, but factors including obesity and smoking keep contributing to new cases.

The economic cost is enormous: Global spending on cancer drugs is reaching $100 billion. There is also the seemingly prohibitive price tag of the individual drugs. Bristol-Myers Squibb’s Yervoy, used for metastatic melanoma, costs $120,000 for four doses, and its effectiveness is limited to increasing lifespan by a few months.

A recent ABC News article on targeted cancer therapies explains that new molecular “designer” drugs, such as Glivec, developed by noted cancer researcher Brian Druker, are “created working backward from a known abnormal molecule specific to a certain type of cancer. Once the molecule is identified, a drug can be designed that interferes with that molecule.” The result is a super-targeted cancer treatment that is less harmful to the rest of the body.

“Big Data” also is getting on the cancer bandwagon. In May, IBM announced a partnership with 14 cancer facilities to utilize IBM’s cloud-based Watson computer system to identify mutations based on the DNA of each patient’s specific tumor. The Watson database contains thousands of study findings, enabling the system to can suggest which drug to target it. It’s not foolproof, but it is the only way to sift through massive quantities of data.

Also relatively new are devices that guide cancer drugs directly into tumors  instead of through the bloodstream. This a more effective and targeted delivery system for certain organs, like the pancreas.

According to the National Cancer Institute, more than 12,000 clinical trials for cancer treatments are underway. The institute’s website lists studies that are accepting new patients. The Sister Study, for instance, is one of the largest breast cancer studies ever attempted, with 50,000 participants tracked over the course of a decade. The research looks to the sibling of a breast cancer patient for clues relating to genes and environment.

Newer, patient-centered hospital models, such as one at Orlando Health, offer comprehensive programs for cancer care. In addition to treatment, Orlando Health offers quality-of-life services ranging from massage and support groups to mediation classes and alternative medicine.

It is widely known that the most common cancers are prostate, breast, lung and colorectal cancers (in that order.) Less known is the fact that that lung cancer has a very low five-year survival rate of 17 percent and prostate cancer has a very encouraging survival rate of almost 99 percent.

While you can’t pick and choose what type of cancer you might develop, it’s worth noting that the American Lung Association states that more than 80 percent of lung cancers can be attributed to smoking. Conversely, according to Cancer.org, researchers have no idea why men get prostate cancer.

Any attempt to put cancer knowledge into a personal perspective can be overwhelming. So what is the takeaway? Perhaps our society should worry less about dying from prostate cancer and focus more on discouraging teenagers from smoking. It may be nearly impossible to stash away millions of dollars in case you need a “designer drug,” but the pace of research and sheer number of clinical trials are giving cancer patients hope.

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