Experts predict that even some of the most fearsome cancers today are increasingly survivable if they’re addressed with care and vigilance.
“We’re moving closer to the situation we have with HIV patients, in that even people with incurable cancers may live for decades,” said Lidia Schapira, a breast-cancer expert and medical professor at Stanford University. “I’m still treating patients who were diagnosed decades ago, while my colleagues are seeing people in their 50s and 60s who had cancer as children.”
The Washington Post reports the National Cancer Institute as estimating that around 2m people in the US will be diagnosed with the disease this year, but that the death rate from all cancers has dropped 33% since 1991.
For some types of cancers, the progress is even more impressive. The mortality rate for lung cancer – the leading cause of cancer deaths – has dropped 58% since 1990 in men and 36% since 2002 in women. Breast cancer is another striking success story, with a 43% drop from 1989 until 2020. So is melanoma, with death rates between 2011 and 2020 falling by about 5% a year for under-50s and 3% or those older than 50.
Memorial Sloan Kettering oncologist Larry Norton said “better early diagnosis, better imaging, better blood tests, better preventive measures and better treatments, including precision medicine with gene-profiling of patients’ tumours” all played a role.
Among all these developments, Norton said he was most impressed by the rise of immunotherapy, a treatment strategy that alters and enlists a person’s immune system to help fight the disease.
Initially controversial, the treatment dates back to the late 1800s but began gaining widespread acceptance in the early 1980s.
Improving care for survivors
Over the past 30 years, as medical progress has made some cancers less lethal, there has also been a dramatic rise in the incidence of some cancers in young people, including cancer of the breast, colon, oesophagus, kidney, liver and pancreas. As the number of survivors increases, and their age decreases, the pressure for change is mounting.
“It is as if we have invented sophisticated techniques to save people from drowning, but once they have been pulled from the water, we leave them on the dock to cough and splutter on their own in the belief that we have done all that we can,” wrote Fitzhugh Mullan, a physician, professor and civil rights activist, in a 1985 essay for the New England Journal of Medicine.
Mullan, who was diagnosed with cancer at 32, later co-founded the National Coalition for Cancer Survivorship, a leading voice for cancer survivors and source of extensive information for doctors and patients. He died of lung cancer at 77.
Following in his footsteps, Schapira, at Stanford, directs the Cancer Survivorship programme, which conducts research and works to help educate patients, nurses and doctors about survivors’ needs.
“Primary doctors recognise it makes a lot of sense for them to be involved, but feel they don’t have the knowledge, time, proper guidelines or even patient records,” she said.
Schapira’s programme has developed a free online course, offering continuing medical education credits, for primary care doctors. The course, “Health After Cancer,” includes videos of four cancer survivors with diverse needs, as well as printable reference guides for clinical care.
“Now, even with incurable cancers, you may live for decades,” Schapira said. Yet that doesn’t mean the living is completely challenge-free.
Many cancer patients are cured but may still need special care because of the cancer treatment they received, she said. After-effects may range from significant emotional trauma to a greater risk of heart disease as a side effect of some cancer-fighting drugs.
While numerous survivors no longer have visible tumours, they must report for frequent follow-up biopsies, blood tests and scans.
Often they require more intensive care, such as continued surgeries, radiation and chemotherapy.
Even so, experts contend that treatment strategies are steadily becoming more tolerable, particularly as oncologists work to decrease the toxicity of medications by giving the smallest possible effective dose.
“The thinking in the ’80s and ’90s was ‘treat and cure the cancer and worry later’, and that has changed,” Schapira said.
Researchers and doctors have also been devising new strategies to combat pain, nausea and hair loss as side effects of cancer treatment.
Norton, of Memorial Sloan Kettering, said: “There’s a mismatch in people’s perception, which I think is heightened by how chemotherapy is portrayed in movies, in books and on TV. I know of a playwright who had a very easy time with chemotherapy but went on to write a story in which a similar patient had all sorts of terrible things happen: her hair fell out; her husband left her; she went through the trials of Job. I asked her, ‘Why did you write it like that? None of that happened to you!’ She said: ‘Do you think I could sell a screenplay saying nothing happened?’”
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