If you noticed a lot of headlines lately about what’s new in cancer care, there was a reason for it: The American Society of Clinical Oncology held its annual meeting last week in Chicago, during which literally hundreds of papers were presented on the latest oncology research findings.
The list of studies that were presented is quite impressive. In the area of HER2/ER breast cancer alone, at least 300 abstracts were submitted for the conference. Other studies addressed cancer prevention, tumor biology, emerging new therapies, and patient and survivor care.
Given this overwhelming amount of information, it would be impossible to cover all the bases. But as I followed the news from the conference this past week, a few things floated to the top:
- A lot is happening in the world of clinical research. Among some of the headlines: “Avastin Boosts Survival in High-Risk Ovarian Cancer”; “Hedgehog Drug Stirs Hope for Some Pediatric Brain Tumors”; “New Regimen Shows Promise in Advanced Renal Cell Carcinoma.”
What I don’t see are significant strides forward. Many of these studies showed benefits that were mostly incremental – a slowing in the progression of the disease, perhaps, or a slight lengthening of survival time. It has now become possible to live longer with cancer, but for all too many patients, death is still the outcome.
It begs the question: How do we define success in cancer treatment? Is the treatment successful if it allows the patient to live six more months but doesn’t cure him or her of the disease? How much should the cost of treatment vs. the likely benefit be a consideration? These issues need more scrutiny.
- If cancer research can demonstrate what’s promising or what’s effective, it also can help identify which treatment strategies are less effective.
A study on options in the treatment of advanced kidney cancer, for instance, found there’s little survival advantage in combining interferon with a monoclonal antibody; interferon alone worked equally well. Another study poured cold water on the notion that selenium could prevent new cancers among people who were cured of non-small cell lung cancer; the selenium didn’t work.
While this may sound disappointing, it does clarify what’s unlikely to help the patient, allowing clinicians to focus on treatment options that hold a better chance of success.
- It was disheartening to see cancer survivorship continue to get short shrift. The master list of abstracts on the ASCO site doesn’t even give it a separate category; it’s lumped in with patient and survivor care, a grouping that also includes cancer-related complications, end-of-life care and “other.”
Patients need to find ways to live well once their cancer treatment has ended. The oncology community must either step up to the plate or ally itself with other specialties – internal medicine, perhaps – to forge improvements in this area.
- One study that should have received more attention than it did: A research team examined what happens when newly diagnosed patients try to make their own first appointment with an oncologist. Research assistants posing as patients were able to successfully make an appointment only 23 percent of the time; 25 percent of the time they couldn’t even reach someone at the scheduling desk. The biggest barrier was that patients had to first send a copy of their medical records before they could be scheduled for an appointment. In about 18 percent of cases, a doctor’s referral also was required.
This may not have been a large or glitzy study but it demonstrated how challenging it often is for patients to navigate the system on their own. Although hospitals and academic centers might think their services are accessible, actual patient experience sometimes tells a very different story.
- The most reassuring message from the ASCO conference: Major time, thought and energy are continually being invested in new and more effective cancer treatment strategies. We know more than we did 10 years ago or even five years ago, and this knowledge is continually being translated into clinical care for real-life patients. Even when progress is measured in small steps, it’s still progress.
Image: Leukemia cells as seen under a microscope. Source: U.S. Public Library of Science