Richard Nixon signed the National Cancer Act in 1971, and since then, we’ve been waging a “war on cancer.” For almost 42 years, we have dedicated billions of research dollars to gleaning insights into the biochemical labyrinth of cancer treatment.
Or, to state the situation more correctly, we have been waging war on cancers with an ‘s’, since each type of cancer–breast, lung, prostate, or any other–has multiple versions or “genotypes.” For example, prostate cancer has 27 identified varieties, which range from indolent to highly aggressive. Cancer’s complexity is surely one reason we have yet to find a “cure” for the disease. Still, there has been progress–death rates from most cancers are declining, and many cancer types can now be treated as chronic diseases rather than guaranteed death sentences. Nevertheless, the American Cancer Society estimates that 1,660,290 Americans will be diagnosed with some form of cancer in 2013. Despite numerous research advances, the war on this disease is far from won.
Our lengthy engagement with cancer has begun feel like stalemate to some, including researchers, medical officials, and patients on the frontlines of this battle. These critics have begun to suggest that reconsider the overall strategy in our war against this disease.
Some of these cancer warriors are even questioning the value of cancer research itself. From an economic standpoint, research has produced a fairly meager return on the enormous investment we’ve made. Dr. Margaret Cuomo, a diagnostic radiologist and sister of New York Governor Andrew Cuomo, has concluded that “cancer research has failed us. . . . Despite decades of promises and a vast amount of funding, the current model has failed. We no longer expect to cure cancer and now talk mostly of living longer with the disease.” Rather than fighting the disease, she states, “our target should be cancer prevention.” She is “deeply disappointed” that out of the $4.5 billion the National Cancer Institute asked Congress for this year, only about $200 million will go to research on how to prevent cancer.*
Advocates of prevention have long excoriated the NIH and National Cancer Institute for treating research into cancer’s root causes—and by extension, into strategies for cancer prevention–as an unworthy stepchild to research into treatment. We already know that we should lead a healthy lifestyle, including maintaining proper diet and weight, exercising, avoiding sunshine, and eliminating addictive habits like smoking. But this prescription is proving insufficient. There must be other environmental causes besides an individual’s habits and lifestyle.
During recent hearings of the Cancer Prevention and Research Institute of Texas (CPRIT), which has funded almost $900 million in research, university scientists and biotech leaders proposed that CPRIT cut back on the money it is pouring into laboratories. As one professor proclaimed, “if people didn’t get cancer in the first place, CPRIT would accomplish much of its mission.”
Oncologist James Salwitz argues that perhaps we should change our entire model of how we think about and treat cancer. Right now, he states, it’s a “chronic illness approach where large numbers of patients spend the last years of their lives debilitated while receiving increasingly toxic and expensive therapy to draw out functionally limited lives.”**
Instead, he suggests, “the concept is to achieve high functioning illness free life for the longest possible time and then have the cycle complete with a short end-of-life acute phase focusing on quality. In other words live a healthy life, to say 90, and then die quickly.”
Is it too radical to propose that before we rush off to the next clinical trial for yet another expensive drug that may extend life a few months, but whose ugly side effects make that extended life less worth living, that we stop and ponder awhile?
Perhaps it’s time to shift resources toward serious research into environmental carcinogens. As Salwitz suggests, it may be time to rethink the overall approach to victory in this seemingly endless war.
Some of us patient foot soldiers certainly feel the time has come for new and creative strategies back at command headquarters.
**James C. Salwitz, “Finding a Cancer Cure: Maybe We Should Shift Gears,” January 11, 2013, http://www.kevinmd.com/blog/2013/01/finding-cancer-cure-shift-gears.html