13 minute read
Only the Beginning Taking Stock 50 Years After the National Cancer Act
Rein Saral
by JOHN-MANUEL ANDRIOTE
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A Rein Saral, MD, was a new researcher at the National Institutes of Health when President Richard Nixon signed the National Cancer Act (NCA) on Dec. 23, 1971.
At the time, a cancer diagnosis was terrifying—and with good reason. Only about half of cancer patients survived five years. There simply weren’t many treatment options. Chemotherapy and radiation were promising, but were still blunt instruments, effective in only a small number of cancers.
That’s changed over the ensuing 50 years. With a stroke of the president’s pen, the “war on cancer” was underway. The NCA infused record amounts of federal dollars into research labs around the country—and helped transform cancer prevention, detection, diagnosis, treatment and survivorship.
TODAY, CANCER CAN STILL BE FRIGHTENING. But for an increasing number of patients, it has become a disease that can be managed—and even cured—through methods that would have seemed unthinkable 50 years ago. Now, the body’s immune system can be harnessed to kill some types of cancer. Blood biomarkers help tailor precise treatment for individual patients. Cutting-edge imaging technology can detect cancer sooner. And aggressive prevention efforts are helping many to avoid cancer altogether.
Most importantly—more cancer patients are living longer.
Winship Cancer Institute of Emory University has helped drive that progress. As Georgia’s NCI-designated Comprehensive Cancer Center, it has led the way on patient care, research and education.
Saral was recruited in 1991 to direct Emory’s Bone Marrow Transplantation Program and has witnessed an “explosion” of new discoveries in the decades since then.
“I think it’s unmatched for any other disease afflicting mankind,” he says, “except, perhaps, some of the vaccine developments we’ve seen here recently.”
PHOTO BY ANN WATSON
Walter J. Curran was Winship’s executive director at the time of its 2009 NCI Cancer Center designation and 2017 designation as a Comprehensive Cancer Center.
DEMOCRATIZING OUTSTANDING CANCER CARE The National Cancer Act “really acknowledged that the problem of cancer needs to be tackled in a coordinated, national way,” says Walter J. Curran, MD, Winship’s former executive director. In 1973, the federal government established the first NCI-designated cancer centers in cities around the country.
“There was already an understanding that not only did you need quality, you needed geographic distribution,” he says.
Some centers focus on underserved groups. Winship, for instance, is committed to Georgia’s large African American population. Having an NCI-designated cancer center in Georgia, and in other states, “has really democratized outstanding cancer care for our nation,” says Curran.
Winship first achieved NCI designation in 2009, and subsequent NCI Comprehensive Cancer Center designation in 2017—marking an important milestone in providing research-based cancer treatment and care for the state and region.
“That would not have existed in the state of Georgia if Emory had not had the discipline over many years to overcome the obstacles to get NCI designation,” says Curran.
WINSHIP’S ROLES IN THE REVOLUTION
Theresa Gillespie, PhD, MA, BSN, FAAN, remembers the funerals.
Starting her career as an inpatient oncology nurse in rural South Carolina, Gillespie says, “I went to a funeral of one of my patients every weekend.”
“We only had so many tools in the toolkit,” she recalls.
Currently a professor in Emory’s Department of Surgery, Gillespie, PhD, says that’s changed.
Theresa W. Gillespie
PHOTO BY ANN WATSON Theresa W. Gillespie, Winship’s associate director for community outreach and engagement, began her oncology nursing career in rural South Carolina in 1981, before coming to Winship in 1986 and organizing its early clinical trials program.
50 YEARS OF ADVANCES IN THE “WAR ON CANCER”
1971
• President Nixon signs the National
Cancer Act on Dec. 23, 1971, effectively launching the “war on cancer.”
It gives new authority to the National
Cancer Institute and establishes national cancer research centers and national cancer control programs.
1979
• First bone marrow (stem cell) transplant performed at Emory by Elliott
Winton, MD, an associate professor of hematology and medical oncology at Winship Cancer Clinic.
Advances in surgery as well as imaging and pharmaceutical treatments.
C
1985
• The Winship Cancer Clinic is renamed Winship Cancer
Center and begins coordinating cancer research and treatment for Emory
University Hospital,
Crawford Long (now
Emory University Hospital
Midtown), Grady Hospitals and the Atlanta VA Medical
Center.
PHOTO BY DR. ELLIOT WINTON
At the Elliot Winton Research Laboratory, scientists continue the pioneering work of its namesake. Tamara Mobley survived multiple myeloma and gladly shares her story to encourage others facing the same diagnosis.
Gillespie’s own role in helping to create that menu began when she came to Emory in 1986 to set up a consolidated clinical trials program. She hired clinical research nurses and data managers and developed standard operating procedures so everybody was doing it the same way.
“We work very hard to develop [clinical trials], and accrue patients, and really make a mark,” she says.
“There have been dramatic improvements and advances in cancer because of contributions from Emory in clinical trials,” says Gillespie, “both investigator-initiated studies as well as contributing to other national trials.” She adds, “That’s a big deal because that’s really how advances are made in terms of patient care.”
Winship has made lifesaving contributions in preventing, detecting and treating cancer. These include demonstrating the effectiveness of biennial fecal occult blood screening that led to a statistically significant reduction in deaths from colorectal cancer; a new method of pediatric screening for neuroblastoma; and developing an amino acid probe that prostate tumor cells take up, allowing for better prostate cancer screening.
In late 2021, Winship’s Bone Marrow and Stem Cell Transplant Center reported it had completed 7,000 transplants, marking the progress since Elliott Winton, MD, performed the first one at Emory 42 years earlier.
Tamara Mobley, multiple myeloma survivor
• Cancer deaths peak at 215 per 100,000 people and then begin steady decline.
1991
A • Winship opens its new 280,000-square-foot, stateof-the-art facility (“Clinic C”) on Emory’s Clifton campus.
2003
C
1999
• The center changes its name to Winship
Cancer Institute.
2006
• NCI selects Emory University and Georgia Tech’s joint research program as one of seven National Centers of Cancer Nanotechnology
Excellence.
Tamara Mobley, multiple myeloma survivor
POSITIVELY IMPACTING PATIENTS’ LIVES
Advances in patient care—new, targeted medications, imaging technologies, radiation and surgical procedures—are the real hallmarks of progress.
Mobley’s doctor, Sagar Lonial, MD, professor and chair of the Department of Hematology and Medical Oncology and Winship’s chief medical officer, is renowned for his pioneering work in treating multiple myeloma. He described some of the giant strides made under the NCA in advancing the research and development of pharmaceutical therapies — drugs, used in combination, that have transformed the once invariably fatal illness into a manageable chronic condition.
“Back in the seventies,” says Lonial, “the only drugs that were available were alkylating agents like melphalan and cyclophosphamide, and corticosteroids. That’s pretty much all you had. And the median expected survival for a patient with myeloma was two and a half to three years.”
It’s very different today.
“You fast forward now to 2020, for instance, when we published our 1,000-patient retrospective paper, all treated at Emory, and the median expected survival is 10 years. And that’s with eightyear-old data,” he says.
“You’ve now got nine or 10 different approvals with different drugs and targets to use all throughout the course of a patient’s journey.”
Offering treatment options is reassuring for patients, Mobley says.
During Lung Cancer Awareness Month in November 2021, Suresh S. Ramalingam, MD, Winship’s executive director and the Roberto C. Goizueta Distinguished Chair for Cancer Research, offered an update from where he stands in the lung cancer pantheon.
“In the United States, deaths related to lung cancer are declining steadily in the past 10 years,” says Ramalingam. “Because of that, we can confidently say that long-term survival is possible even with advanced stages of lung cancer.”
Ramalingam credited investments and research into personalizing therapies, new treatment approaches and immunotherapies to treat lung cancer.
“We now have a platform that positions us well to move to the next higher level by pushing research and care towards improving the outcomes for all patients with lung cancer,” he says.
CHANGING THE PARADIGM TOWARD PATIENT-FOCUSED CARE AND QUALITY OF LIFE
In the 1980s, Deborah Watkins Bruner, RN, PhD, Emory’s senior vice president
• Winship earns prestigious cancer center designation from NCI.
• Walter J. Curran, Jr., MD, appointed new Winship executive director.
• Winship opens Phase I Clinical
Trials Unit.
2009
E • Winship is first in the
U.S. to test new brain tumor drug.
2012
2010
• Changed official name to Winship Cancer
Institute of Emory
University.
G
2013
• Glenn Family Breast
Center established at Winship.
PHOTO BY STEPHEN NOWLAND
Deborah Watkins Bruner, Emory’s senior vice president for research, professor and Robert W. Woodruff Chair in Nursing
Deborah Watkins Bruner for research, professor and Robert W. Woodruff Chair in Nursing, says clinical trials were focused primarily on gathering morbidity, mortality and physicianreported outcomes.
“It wasn’t even until 1989 that the NCI put out a call for patient-reported outcomes to be measured in clinical trials,” says Bruner.
Bruner was among a group of researchers whose work led to a paradigm shift in the assessment of clinical trial outcomes. “And now,” she notes, “patient-reported outcomes have become a standard focus of especially large phase 3 clinical trials.”
A presidentially appointed member of the NCI National Cancer Advisory Board, Bruner was recognized in 2021 as one of only 14 scientist “Champions and Changemakers” in cancer prevention and control. While she said she is “extremely honored” to be named, she pointed to a bigger backstory that marks another dimension of progress. RAISING AWARENESS OF DISPARITIES
One thing researchers need is data. The NCA established population-based registries to count the incidence and mortality numbers needed to figure out who is getting cancer, what stage they are in, how long they have to live and who is dying. Atlanta, Emory specifically, became one of these registries beginning in 1973.
“This is incredibly important,” for knowing how cancer is affecting different subsections of the population, says Otis Webb Brawley, MD. Now the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, Brawley was formerly Winship’s deputy director for cancer control.
Brawley, who co-chaired the US Surgeon General’s Task Force on Cancer Health Disparities, explained that this new data for the first time allowed researchers to recognize how racial,
• NCI selects Winship as lead academic participating site in the National Clinical
Trials Network.
2014
A • Winship earns elite
Comprehensive Cancer
Center designation from NCI.
• New Emory University
Hospital Tower welcomes its first cancer patient.
2017
• Congress creates Cancer
Moonshot initiative to invest in research with the potential to transform cancer care, detection and prevention.
2016
• The Emory Proton Therapy Center treats its first patient.
C
2018
D PHOTOS BY: A. STEPHEN NOWLAND, B. JACK KEARSE, C. JACK KEARSE, D. JACK KEARSE, E. JACK KEARSE, F. DR. WALLER, G. JACK KEARSE
economic and social disparities factor into patient outcomes.
GAZING IN THE CRYSTAL BALL
Where will the momentum that has built up since passage of the 1971 National Cancer Act take us next? Longer survival and more effective treatments, for one thing.
Lonial expects the near future could hold even more remarkable advances for multiple myeloma patients.
“The new paradigm is using all the tools we have,” he says. “Putting them together in a limited duration treatment so that you can ultimately stop and hopefully will have cured a large number of patients.”
Curran foresees more personalized therapy.
“We’ve already seen a rapid shift to much more individualized plans,” he says, “much more individualized ability to predict the benefit of one therapy over another for patients. I think we’re going to see, over the next years, not only some new categories of care, as well as diagnosis, but a better ability to sort of work with a patient to say, ‘If we go down path A, we think there’s a one out of three chance of success. If we get on path B, we think it’s one out of two chance,’ and so forth.”
Saral recalls a symposium he attended in 1972, where participants offered predictions for the year 2000. “These were the smartest people in the field that I’d been involved with, and a lot smarter than I was,” he says. “And you know what? Thirty years later, in 2002, every prediction they made was wrong. We had advanced much more rapidly than anyone thought.”
Saral looks back across the decades since the National Cancer Act’s signing, and looks ahead too. “It’s a remarkable story,” he says. “But it’s only the beginning.” w
Sagar Lonial, director of the Department of Hematology and Medical Oncology, and Winship’s chief medical officer, is renowned for his pioneering work treating multiple myeloma.
Sagar Lonial
• NCI awards Winship the prestigious Lung Cancer
SPORE grant.
• Groundbreaking held for the new Winship at Emory
Midtown tower, set to open in 2023.
2019
• NCI funds Winshipled study of COVID-19 immune responses in patients with cancer.
E
2020
• Winship multiple myeloma team awarded prestigious center of excellence grant.
• Winship treats first lung cancer patient with
T-cell receptor therapy.
2020
• Suresh S. Ramalingam, MD, appointed Winship’s new executive director.
F
