Defending the call for a cancer moonshot

In his last state of the union address, President Obama reinvigorated the nation’s interest in a long-sidelined disease/s: cancer. A call for a moonshot was announced, and the president in his address said, “I’m putting Joe in charge of mission control.” The last time such a national commitment towards this illness was announced was by the efforts of a cancer advocate, Mary Lasker. She advocated fiercely, and the National Cancer Act was signed by President Nixon. Passage of the Act increased federal efforts to fight cancer. It created the National Cancer Program, which is led by the National Cancer Institute. It ensured a steady stream of funding for cancer researchers. The sad part is that it all happened in 1971 — a whopping 35 years ago; I wasn’t even born then! Since then, the cancer funding has been slipping down slowly. Adjusting for inflation, NIH funding is down 20 percent just over the last decade.

The president’s announcement and the vice-president’s commitment should have been welcome news for the country, especially the cancer community. But this initiative met with a considerable amount of criticism. The New York Times criticized the ambition with the headline: “Moonshot to Cure Cancer, to Be Led by Biden, Relies on Outmoded View of Disease.” Oncologists took social media by storm, calling the initiative unrealistic. The major source of outcry is referring to cancer as one disease entity.

Research in the past few decades has shed unprecedented light on cancer. We oncologists now believe that cancer is not just one disease, but hundreds, maybe thousands of different diseases. Each cancer or each disease, in need of a distinct treatment option. For example, treatment of breast cancer is very different from a blood cancer. More so, there is tremendous variation within the cancers affecting one organ or a body part. Hormone receptor positive breast cancer is as different from hormone receptor negative breast cancer, as the city of New York is from the city of Los Angeles: each having their own distinct character, behavior and needs.  That being said, good luck explaining this to the average Joe out there listening to the State of Union address. The technicality of this disease is very hard to convey to a lay person. It took us decades to understand the heterogeneity of cancer; we should not expect the lay public to understand this overnight.

People have been critical of the use of the word “cure’” in the moonshot. When Mr. Biden announced from the Rose Garden that he is not seeking a run for the president’s office and that he is initiating a campaign to “cure cancer, as we know it,” more than a few eyebrows were raised. Words like “American jingoism,” and “nebulous concept” were used.

In the world of oncology, the word “cure” has a very different meaning than what is understood outside of the medical sphere. Put simply, cure means never hearing back from cancer ever again. The other word, which we oncologists commonly use, is “treat.” Treatable cancers are the ones, where the treatments are likely to prolong the patients’ lives, but cancer will ultimately shorten their lifespans. Most of us believe that we are currently at an inflection point in science, where a majority of the cancers going forward would be “treatable,” while “cure” remains an ideal goal. The use of the “C” word, not cancer, but cure, has the medical community all riled up. Once again, the technicality of this distinction is nuanced, which may be hard to convey to the average Joe out there.

While the dollar amount committed to this valiant effort may appear small (around $800 million, in an industry where billion dollar biotech debacles are commonplace), we must welcome the expertise that the VP brings. In a recent meeting with cancer researchers about breaking down the silos in cancer care and exploring combination treatments, the VP said, “The overwhelming inclination of all of you is if you combine the two it may be better, but getting that done is like, y’know, getting a nuclear deal with Iran, only we were more successful. The science is ready. We have to figure out a way to share information more.”

Biden’s skills as a convener and collaborator could make a lasting difference in accelerating research.  He hopes to streamline cancer funding and remove the red-tape involved in getting funding for the researchers. In his characteristic witty way, he said, “We slow down our best young minds before they can get their own grants, and when they do, they spend a third of their time on grant writing. It is like asking Derek Jeter to take a year off to sell bonds to build Yankee Stadium.”

Some may call this initiative overly ambitious, but if we go by history, our last moonshot was a success. And I am certainly hoping for the same this time.

Saurabh Dahiya is a hematology-oncology fellow.

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