To Improve Outcomes, We Must Find Ways to Optimize Prevention, Diagnosis and Treatment Across Cancers
Progress in cancer comes slowly, in bits and pieces and not in sudden bursts of success. And even when “breakthroughs” happen, it usually takes a long time to confirm that the early results actually make a difference.
BY Len Lichtenfeld, M.D.
PUBLISHED August 15, 2019
Progress in cancer generally comes slowly, in bits and pieces and not in sudden bursts of success. And even when “breakthroughs” happen, it usually takes a long time to confirm that the early results actually make a difference.
So, imagine my surprise when I was reviewing some information recently about the declines in deaths from melanoma. It turns out that, from 2012 to 2016, melanoma deaths declined an average of 4.8% each year for whites and 9% a year for blacks. That is a stunning reversal in a disease that, for decades, was essentially resistant to treatment efforts when it spread through the body.
Why did that happen? Truthfully, we aren’t certain. It could be that people are recognizing melanoma earlier, when it is more treatable. However, most of us would probably point to the introduction of targeted drugs and immunotherapies, which only started to become available at the beginning of this decade. It appears that the impact of these new treatments on this disease has been rapid and impressive — notwithstanding that we still lose too many people to metastatic melanoma.
This raises a question for me: Is it possible we will see similar declines in mortality for other difficult-to-treat cancers, such as lung cancer? My thought is that such an outcome is not out of the question, especially where new treatments like immunotherapy may be effective.
Over the past several years, we have learned much more about lung cancer, and several new agents have been introduced into the clinic. Both targeted drugs and immunotherapies, including new approaches such as combining chemotherapy and immunotherapy, are starting to generate long-term, meaningful responses in some patients — primarily those who have never smoked.
Complementing this improvement is that smoking rates have dropped, and with them the incidence of those lung cancers associated with this chemical exposure.
People I respect are now asking what we need to do to make certain that everyone diagnosed with lung cancer has access to the best tests at diagnosis and receives the best treatment for their disease.
To make that happen, we need to optimize every step of the cancer journey, including prevention, early detection, appropriate diagnosis and staging, treatment, and supportive care. That will mean developing new approaches, such as using data analytics to monitor individual patient progress and system performance, and employing precision navigation to ensure that those in need get the assistance required through every step of the journey.
Optimization could help people with other cancer types, as well.
In breast cancer, some cases are due to inherited predisposition, so ensuring that relatives of these patients are offered genetic testing and enhanced surveillance could save more lives. Better public awareness and access to detection and treatment could reduce dangerous delays in treatment, and measures to help women comply with long-term hormonal drugs could also make a difference.
For rarer cancers like sarcoma, referral programs are needed to get patients to doctors with special expertise.
We need to be able to assure every patient and family that they are receiving the best prevention, detection and treatments available and offer them the support they need to get safely through the journey. If we could accomplish that goal, we would make considerable progress in reducing the burden and suffering from cancer.