Words have meaning. And when it comes to cancer, especially advanced cancer, there aren’t many words that have more meaning than the word “cure.” It is that very word and concept that is top of mind for some of us these days.
We clinicians are guilty as charged when it comes to reluctance declaring those who have had a remarkable response to treatments for advanced cancer “cured.” Experience has taught us over decades that we have misused the word and overpromised those we cared for. Our patients and loved ones have paid a price for our over-optimism. Consequently, our culture has taught us to avoid the word, lest we be shown to have been less-than-truthful when cancer returns with a vengeance.
And yet our world is changing: we are now seeing long term responses to treatments in diseases where until recently we had little hope of such success.
Recent reports of rapidly declining mortality in melanoma, normal life spans for many people treated for previously fatal diseases like chronic myelogenous leukemia, and the potential for impressive gains in outcomes for people with lung cancer are but a few examples that suggest we are indeed in a new era for cancer treatment.
So why shouldn’t we be talking about a cure for cancer?
From my perspective, there are a couple of ways to look at this concept:
- Our research is taking us to new understandings and treatment for several cancers. Although some of these treatments may target only a small number of patients, taken together they will make a difference in the burden and suffering from cancer. We cannot and should not ignore the fact that there are more patients surviving longer because of these new treatments, some returning to full-time employment and many returning to a meaningful quality of life that would not have been the case even a few short years ago.
- Our past should not be a barrier to our future. We should embrace the concept of cure, always keeping it top of mind, and aiming for the greatest goals we can achieve. We should accept — as I heard the former director of the National Cancer Institute and current interim commissioner of the Food and Drug Administration, Dr. Ned Sharpless, say last year in an address to the annual meeting of the American Society of Clinical Oncology that we need to address and embrace the “C” word — and appreciate that today it is within our reach for some, and soon hopefully many more.
Then there is a fundamental question: What really is a cure, and how could we make it happen?
To me, “cure” in its broadest sense is a complex equation consisting of education, awareness, access, timely diagnosis, best available treatment, and availability of the support to get through a cancer journey. At its core, “cure” is avoiding a preventable or premature death.
In that respect, we have been successful: a 27% decline in the rate of cancer deaths from 1991-2016 is proof positive. However, I firmly believe that if we optimized cancer care starting today, we could vastly reduce deaths from cancer, maybe even avoid hundreds of thousands of deaths by simply doing what we already know.
That may not be as provocative as “cures,” however the impact would be the same: avoiding cancer, finding it at a more treatable moment, getting the best available treatment. That’s what counts in reducing the cancer burden.
So instead of focusing on whether it’s appropriate to set audacious goals of curing cancer in a certain period of time, let’s focus on what we have accomplished, what we could accomplish, and what we will accomplish by confronting cancer in all its complexities, from prevention and early detection to treatment. Let’s make certain everyone knows what they could do to reduce their risk, and let’s make certain everyone has access to appropriate early detection that has been proven to work. Let’s make certain access to care is not an impediment but an opportunity to get care, and when that care is provided it is the best available care with the right treatments.
“Cure” may be a bridge too far for some, however, it should be a goal for all. And unless one makes big goals, we will continue to avoid big successes. The cure for cancer is, in fact, within our grasp. Let’s not ignore that opportunity to do better.
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