Cancer in the New Century
When treating cancer in the new century, patients and their stories will come first, said Siddhartha Mukherjee, MD, DPhil. During a session analyzing the evolution of cancer detection and treatment, Dr Mukherjee said that stories “animate” cancer and help to personalize the patient’s experience as they deal with treatment.
Using his own 2010 Pulitzer Prize-winning book The Emperor of All Maladies: A Biography of Cancer as his guide, Dr Mukherjee documented key points in cancer history. He started as far back as cancer’s first identification in ancient Egypt, and discusses how early recognition of “bodily fluids” in ancient Greece shaped the first identification methods for cancer. From there, he described the 19th century surgical techniques of removing cancerous tumors, which often left patients disfigured. Early uses of radiation therapy also led to adverse effects in patients and researchers; not to mention that later, smoking-habit trends of Americans in the 1940s and 1950s led to an epidemic of smoking-related deaths. The epidemic continues to be a problem in the battle against cancer.
His lengthy discussions of cancer’s early prognosis and treatment options served to accentuate how once commonly accepted concepts about cancer are now seen as grossly misguided by practitioners. Of course, each misstep has also led to better, more progressive options in cancer care. Understanding cancer’s history helps to shape providers’ understanding of cancer’s present, and ultimately, its future.
Dr Mukherjee used the opportunity to quickly shift the discussion to developments in modern medicine, including the “age of targeted therapy” and the breadth of pharmacology. Cancer isn’t static, he argued. It’s an “organismal disease,” constantly moving and interacting with its environment. And, like any true organism, cancer is complex.
He said that cancer care requires several paradigm shifts, including the move from “try and try again,” to “fail fast and early.” If a method is proven to be ineffective, providers should be able to accept it as just that—a failure. There should also be a move from personalizing cancer treatment later, such as in clinical trials, to personalizing the experience right from the start. He stresses the importance of remembering that people have cancer, that there is more to them than just the disease. Personalizing will also be key in cancer treatments themselves, especially as genomics and targeted therapies continue to develop and evolve.
Dr Mukherjee added that the advancement of cancer treatment will be an ongoing process that shouldn’t be seen as having an end point. “But don’t be disheartened,” he argued. Rather, in understanding the past, we will grow from what we know today. To make advancements, the agenda must keep moving forward.