Cancer patients: The heart of the matter
It's strange how a person's interests converge sometimes. Last month, cable network Showtime aired a two-part documentary on one of rock-and-roll's biggest bands, the Eagles. I, a professed "Eaglemaniac," of course tuned in. For more than three decades, the Eagles' lyrics have fascinated me, and as I get older, they take on new meaning. This month, I viewed them within the context of the other thing dominating my life at the moment: our annual cancer issue.
In 2009, from the floor of the American Association for Cancer Research's (AACR) 100th Annual Meeting, I wrote that I had never personally known anyone diagnosed with cancer. Last year, I shared that cancer had affected many people in my life in various ways. This year, I'm sad to report that it's hit close to home. In December, my uncle J.D. passed away after an all-too-brief battle. In January, it called home Beth Dunlap, the lovely wife of our contributing editor, Lloyd Dunlap. And it continues to wreak havoc in the life of Mihaela Puscau, a friend's wife, whose fight against Hodgkin's lymphoma I shared with you at this time last year.
Yet, despite these personal experiences, and a continued increase in our cancer-related news coverage, there's a lyric by Eagles frontman Don Henley that sums up how I view cancer right now: "The more I know, the less I understand. All the things I thought I'd figured out, I'm learning again."
So let's, as Henley advises, get down to "The Heart of the Matter." Where are we in cancer diagnosis, treatment, research and drug discovery? Breakthroughs in cancer research—from vaccines to genomic findings to delivery mechanisms, and all that falls between—continue to be made at such a fast pace that in 2011, we created a new website, ddncancer.com, just to keep up with all of the headlines. In this issue, we have a special report on regulatory issues in oncology drug development, a preview of AACR's show next month, a guest commentary, a market research report and more than a dozen stories that somehow involve cancer.
But for all of these advances, at the same time, the three personal cases I mentioned above tell a far different story: one of frustrations, complications and a feeling of alienation from cancer patients and their families.
In my Uncle J.D.'s case, timely and proper diagnosis—or lack thereof—played a significant role in his quality of life in his final months. Initially and wrongly diagnosed with a blood-clotting disorder, his cancer went undiscovered and untreated for who knows how long. By the time his diagnosis was corrected, it was too late. His passing was swift and shocking. My family is still trying to get all of the details on his illness and demise.
In Beth's case, she was treated for both a brain tumor and breast cancer. Television ads for cancer centers in Chicago, near the Dunlaps' home, boasted that their patients get "better care and cure rates," Lloyd says, but he adds, "From my experience, there are many drugs to treat cancers, but few that affect cures. There seems to be more emphasis on positioning many cancers as 'chronic' diseases. Perhaps the silver bullet is just too elusive for most cancers, but it has to be noted that long-term cancer drug therapy is very lucrative—much more so than a drug that cures over a short treatment regimen."
Still, the mere mention of a cure "contributes to false hopes among cancer sufferers, and terrible angst among their caregivers," Lloyd continues.
"Should I have gone shopping for a resource that would have offered more hope?" he wonders. "Or is this picture nothing more than added evidence that the healthcare 'industry' is exactly that? Is pharma really focused on curing cancer?"
Sorin Puscau, Mihaela's husband, agrees, but is more blunt. Mihaela's battle with Hodgkin's lymphoma has encountered significant obstacles: a shortage of the chemotherapy drugs she needed; short-staffed cancer treatment centers; the need to travel across the country to get a bone-marrow biopsy; and now, finally, stem cell collection and an autologous transplant. Like Lloyd and Beth, the cost of Mihaela's treatment has also been an issue, but the Puscaus have been lucky—they have good insurance, and Sorin has a compassionate employer who has helped to ensure that Mihaela will be able to continue her treatments.
Holding a position in the finance and energy industries, Sorin views the situation from a sophisticated lens. Considering the economics of cancer research and treatment, he has come to the very bleak conclusion that what cancer patients want and need most is a cure, not endless, expensive, ineffective, weakening treatments—but it's the latter that the pharma industry feels is better for business, he says.
"Curing cancer would bring a high economic impact. It could be devastating," Sorin asserts. "The plastics, the syringes, the staff, hospitalization, electricity consumption, etc. It could have a very broad impact. I'm not a crazy person who is suspicious about population control, but I think that not finding a cure could also impact the human population and available resources. Who will pay to distribute them if there is an increase in the population?"
So when it comes to cancer treatment, what's the "silver bullet" that Lloyd describes? It may depend on the type of dog you have in this fight. If you're a patient or a patient's family, it's probably a cure, the total elimination or eradication of the disease. If you're a doctor, it may be prescribing the best possible treatment available, while maintaining a certain quality of life for your patient.
But if you're in a position to create treatments for cancer, what's the silver bullet for you? Is it creating a safe and effective blockbuster drug that brings in the revenue your company needs to continue work on future drugs? Is it an altruistic quest for a cure?
The three personal experiences I have shared with you have only made these questions loom larger for me. Henley sings, "These times are so uncertain; there's a yearning undefined, and people filled with rage." I think it's time we get down to the true heart of the matter: Deciding what the goal of cancer research should be.