Dec 15, 2016
Getting to the End of Cancer
Approaching the vision for the end and how to get there
By Elizabeth Mendes
While experts agree that eliminating all forms of cancer is likely not possible, they do believe cancer can one day become much more rare and much less deadly.
“One of the paradigms that I think is going to become more and more important is turning cancer from an acute, debilitating, fatal disease into a chronic disease,” says Kevin Shannon, MD, a long-time cancer researcher and pediatric oncologist at University of California San Francisco Helen Diller Family Comprehensive Cancer Center. “For example, in the early 1980s into the 1990s, HIV was an acute, uniformly fatal disease. Now HIV is a disease people live with,” says Shannon. He says that for some adult cancers, particularly in older people, figuring out ways to develop drugs to allow people to live with cancer at a “low level” will be very important.
Shannon says we are already seeing that in some cancers, such as multiple myeloma and chronic lymphocytic leukemia (CLL), which primarily affect older people. “I don’t know that anybody in those fields claims that patients are really ‘cured,’ and you can always find some residual leukemia cells. But what happens is we now have so many new drugs coming down the line that when the CLL, for example, becomes resistant to one, we try another one, and another one,” says Shannon.
“So the older individual who has CLL, she or he, they can go to the wedding of their child or appreciate the birth of their grandchildren because they are living much longer, and they are living well.”
How do we get there? In previous sections of this publication, we’ve touched on some of the highlights: continued investment in the paths of prevention, treatment, technology and basic biology, such as epigenetics. To boil these down to two big buckets: experts point to a need for more and better cancer science and multidimensional improvements in the health care ecosystem (from education to access). Breakthroughs in these areas will have a staggering impact.
Advancing our fundamental understanding of cancer
Biochemist Bruce Alberts, PhD, former president of the National Academy of Sciences, has been studying cancer for more than 50 years. He says that gaining more knowledge about fundamental cellular processes that “we don’t fully grasp yet” is “going to be essential in the long run to doing much more sophisticated forms of cancer treatments.” “Basic understanding is so important for our future for cancer,” says Alberts.
Alberts says he is optimistic that eventually we will understand everything there is to know about the basic biology of life, but he says, “it’s going to take a long time and it’s going to take a lot of scientists.”
A key way to improving our fundamental understanding of cancer? Alberts says we need to change how science is done. “Our most talented young people should have a chance to have an independent laboratory much earlier than they do now. Now they are something like 40 years old when they get their first independent grant.” Alberts fears we are “losing all of this energy and enthusiasm of young people to Silicon Valley, for example.”
Alberts also fears young scientists are getting “boxed in to the same set of ideas” — encouraged to work on familiar problems rather than innovate.
“I would like to see a new program both at foundations and at the US government that specifically focuses on empowering the best young people to do their own thing — take a risk, try something creative,” Alberts says.
“I think a lot about all of the experiments that are not being done.”
Bringing everyone along
Even with deep knowledge of how to prevent cancer, and all the tools and medicines to cure it or manage it, many people still will be left out of the progress. As Richard Wender, MD, chief cancer control officer at the American Cancer Society (ACS), noted, reducing the cancer burden for everyone would take tremendous changes in both lifestyle and health care delivery systems.
An abundance of research highlights the need for more affordable medicines, as patients who have trouble paying their bills are more likely to skip or delay their care and not fill prescriptions. And the cost of the newer, cutting-edge treatments is presenting an even greater challenge. Immunotherapies for cancer, for example, can cost hundreds of thousands of dollars a year.
Beyond drugs, the basic ability to get to care and navigate the health system can mean the difference between life and death. Numerous studies have shown how difficult it can be for certain populations to access oncologists, cancer centers, and even places to get cancer screenings. For example, one recent analysis by ACS researchers found that travel distance was a clear barrier to radiation therapy for patients with stage II and stage III rectal cancer.
Even when patients have access, a lack of familiarity and resources to deal with the health system can be a show stopper. Giving a patient one-on-one help with this can make a major difference. Patient navigation is an example of this kind of help. “The idea of the patient navigator is that they really look at these social issues that have an impact on medical care. It could be economic barriers. It may be that they don’t have childcare. It could be fear,” says ACS research professor Karen Freund, MD, who was one of the National Cancer Institute’s Patient Navigation Research Program investigators. “We’ve heard anecdotes from patients saying, ‘I was going to give up on that chemo, but then the patient navigator wouldn’t give up on me.’”
Creating the end that we all hope for
Getting to an end of cancer is going to take scientists, doctors, nurses, corporations, policymakers, community leaders — including all of us. As many people as possible will need to work together toward a complete understanding of cancer and a way for everyone to benefit from it. The end of cancer is being created day by day. The eventual goal may seem far off, but for the ever-optimistic scientist Alberts, “the impossible often does become possible.”
Interested in learning more about American Cancer Society research? Get more insights at cancer.org.
