Cancer as a Chronic & Manageable Disease

At a national conference June in Washington, DC, a distinguished group of more than 30 leaders in the field of cancer were interviewed on the advances made in targeted diagnosis and treatments that could turn the disease into a chronic and manageable disease by 2022.

Based on these interviews, a specific algorithm of the goals for turning cancer into a chronic illness was established:

• Greater use of molecular biomarkers
• Use of molecularly targeted therapies in combination to form a personalized "cocktail" approach for each patient
• Evidence-based physician/patient decision making
• Development of regulatory and reimbursement policies to advance targeted therapies

The keynote speaker at this meeting was Siddartha Mukherjee, MD, the author of a captivating biography of cancer, The Emperor of All Maladies. He agreed that the complexity of cancer treatment today remains a major barrier to scientific discoveries and new medicines. He used the term "combinatorial diversity" to describe the complexity of gene combinations, and he cited a patient case history of a woman with two distinctly genetically different breast cancers in the same breast requiring completely different treatments.

A second theme noted at this conference was the necessity of continuous rapid learning in the healthcare system as advocated by the Institute of Medicine and the American Society of Clinical Oncology, as well as seamless linkages in research and patient care. Most importantly, participants said that cancer care must always be centered on the patient's needs and values.

I do not think these are necessarily surprising themes, considering we all work for the benefit of patient care, and newer technologies and treatment decisions will ultimately affect their well-being. When I ask my patients about the possibility of turning breast cancer into a controllable, chronic condition (much like diabetes, which can be controlled by taking insulin), most agree that that potential would take the anxiety out of the likelihood of recurrence and give greater peace of mind. If that day came, we would all breathe a great sigh of relief.