by Dave Gardner
Ongoing improvements in the war against cancer include evolving screening techniques, the use of comprehensive specialty teams, and new weapons from the arsenal of science to create multiple treatment choices.
Anand Mahadevan MD, professor and chairman of radiation oncology with the Geisinger Health System, commented that the medical community as a whole is fully committed to improvements in cancer care with screening and early detection, maximization of treatment for cost and value, and offering treatment choices with minimum toxicity, radiation and damage to the patient. Big strides have been made during the past few years as physicians move away from treatments such as conventional radiation and chemotherapies that can harm a patient, in favor of immunotherapy that enhances the body’s immune system to kill targeted cancer cells.
The battle against breast cancer is also benefiting from better use of screens. One area involves three-dimensional mammograms, which have proven to be helpful in early detection of breast cancers even though this is actually an enhancement of existing technologies.
In a big change, the U.S. Preventive Services Task Force is now recommending yearly lung cancer screening with low-dose computed tomography for anyone with a history of heavy smoking, currently smoking, those who quit within the past 15 years and who are between 55 and 80 years old. This advancing technology allows the oncologist to study detailed pictures of the patient’s lungs, thereby encouraging early detection of a cancer.
This contrasts with the situation involving prostate cancer screening, where Dr. Mahadevan described how many physicians have decreased blood screenings because excessive treatment was being applied to cancers needing no action. Yet, he described how the situations with many brain and pancreatic cancers are frequently the opposite and deadly, because by the time they are found they there often fairly advanced.
“The use of the immune system to fight these cancers shows great promise,” said Dr. Mahadevan. “Plus, if pancreatic cancer is found, it overall is no longer the death sentence it used to be. With brain cancer we have in many cases doubled the length of a patient’s life, but there’s still lots of work to be done.”
As the war against cancer has evolved, big changes have occurred in the way patients cope with a diagnosis. In many cases, according to Dr. Mahadevan, they gain a factual understanding of their situation through information on the Internet, and this subsequently changes the way they often regard a diagnosis and now question physicians thoroughly with requests for a second opinion.
“For example, 30 years ago a patient simply accepted whenever their physician said, but as patients have become more informed this is no longer the case,” said Dr. Mahadevan. “Knowledge can help the physician to assist a patient being overwhelmed by the multiple choices they may have to make.”
Integral to this modern treatment process is the relatively new use of comprehensive oncology teams. The process usually begins when a patient goes to a primary care physician because of symptoms, and is then sent to a specialist who does a biopsy and confirms a diagnosis of cancer.
The multidisciplinary approach then begins, and as opposed to the time when surgery, chemotherapy and radiation were the only choices, cancer patients will now be treated by a team that includes social, psychiatric and behavioral therapists, dieticians, physical therapy specialists, plus the central medical caregivers.
“This team will now study each individual cancer, determine what is best for that patient and present the options,” said Dr. Mahadevan.
Despite advancements in cancer care, bad news still must be delivered. Dr. Mahadevan related how young people often process this information with fright and worry about the future, while older people may accept the diagnosis with more restraint and frequently commit their remaining time to be with family.
Looking ahead, Dr. Mahedevan is optimistic about advancing cancer research at the molecular and atomic levels. He can envision a time when, after a baby is born, his or her blood will be tested to generate genetic predictions about the possibilities of certain cancers in the future, as well as options to stay healthy in a world where cancer has become only a chronic problem like high blood pressure.
“Current research is showing that the majority of cancers are sporadic and occur with unknown origins,” said Dr. Mahadevan. “The number two cause is behaviors such as smoking. The third cause is genetic, which means the patient was dealt some bad genes which inevitably bring on the cancer, and all of this must be considered as the battle against cancer moves forward.”