Better Health Cancer

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By K eith O ’C onnor

Special To The Republican Cancer has been around since the dawn of time, yet scientists believe it is unlikely that we will find a single cure for cancer in our lifetime.

“Cancer is a vast and complex set of diseases with interrelated genetic, environmental and inherited causes, often worsened by other conditions patients may have,” said Dr. Wilson Mertens, medical oncologist with the Baystate Regional Cancer Program at Baystate Health and professor emeritus of medicine at the UMass Chan Medical School—Baystate.

“This leads to many different potential treatment targets and approaches, making a single therapy unlikely.”

Cancer is the leading cause of death worldwide. The American Cancer Society (ACS) predicts 1,958,310 new cancer cases and 609,820 cancer deaths this year in the United States. Despite the grim statistics, the good news is more people are surviving cancer than ever before. The ACS predicts 22.1 million survivors in 2030, with a 5-year survival rate.

“While there is much to be accomplished in our fight against cancer, the decrease demonstrates the increasing effectiveness of our efforts,” Dr. Mertens said. “This includes cancer screening, but especially new cancer therapies harnessing patients’ immune systems, as well as treatments targeted to specific molecular characteristics of the cancer.”

Scientists recently discovered evidence of a deadly bone cancer called osteosarcoma in a fossil leg bone from a dinosaur millions of years ago. The first documentation of cancer in humans, however, only dates back 5,000 years to ancient Egypt in a papyrus document describing tumors found in a woman’s breast.

Only in the past 200 years have there been many landmark discoveries increasing knowledge of the nature of cancer and how to treat it effectively. The advent in 1946 of general anesthesia opened the door for modern cancer surgery. Radiation was first used to treat cancer in 1903 with further enhancements leading to modern linear accelerators in the 1970s. These devices – Baystate has four of them – are the main method of radiation delivery today. They are highly sophisticated and deliver therapy with increasing accuracy, often focused on the tumor itself, improving results with less side effects.

Nitrogen mustard was found during World War II to have potential anticancer effects, leading the FDA in 1949 to approve it for the treatment of lymphatic cancers and paving the way for modern chemotherapy. Today, drug therapy includes antibodies engineered to attack specific proteins and receptors on the cancer cell or enhance the patient’s immune response to the cancer, or even deliver a chemotherapy drug directly to the cancer cell. And those are just a few of the many advances to benefit patients.

Dr. Mertens offered his thoughts on what he considers the biggest two advances in the fight against cancer – the first being the ability to conduct clinical trials.

“We need to prove that the interventions we are using are making a difference in terms of improved survival and not just reduction of cancer growth. There are always going to be new scientific developments, but we need a statistically sound structure to prove we are doing something worthy. Clinical trials, which have grown tremendously in numbers since the late 1960s, have allowed us to build progressively on our past treatment approaches,” Dr. Mertens said.

“Current clinical trials include early-phase studies intended to determine if a drug is effective in treating a specific cancer, or increasing- ly a specific characteristic that might be shared by many cancers, as well as large studies designed to show if a treatment will help a patient live longer. Both types of trials are available at Baystate Health, and new studies are starting frequently,” he added.

The second advancement is a team approach, something he learned the importance of and brought to the Baystate Regional Cancer Program after seeing a patient during his residency in Ontario, Canada. The patient suffered from ovarian cancer but struggled to find the appropriate specialists and had delayed diagnosis and uncoordinated management of complications.

“We have surgical, radiation, gynecologic, medical and hematologic oncologists that care for patients today along with other medical specialists such as gastroenterologists, endocrinologists and many others - everyone has a cancer role to play.

Nurses, pharmacists, radiation technologists and care coordinating staff are critical to the delivery of modern, complex cancer care. Cancer is managed by people for people, and it is important to include everyone’s special contribution, knowledge and skills for the betterment of our patients at the right time, in the right setting, for the best outcomes. It has taken a while to achieve, but being able to offer the best that all our medical specialties can offer in a coordinated fashion is a truly critical advance,” Dr. Mertens said.

Coordination efforts abound at Baystate, including patient care coordinators, tumor conferences - there are 10 that meet regularly - and disease-specific treatment teams that enhance care management and knowledge as well as improve patient care flow.

Can cancer be prevented?

It’s a question that Dr. Mertens said he often hears from patients, noting the answer is that it is all about modifying risk factors to lower your chances of developing cancer.

“Aside from genetics and family history which are not modifiable, avoiding tobacco and limiting alcohol use, not being overweight, keeping physically active, protecting yourself from the sun, practicing safe sex and other healthy lifestyles can reduce your cancer risk. The campaign to stop smoking has been somewhat successful, reducing cancer deaths over the years, but we haven’t made strides in areas such as obesity or getting people off the couch. Most cancer screenings such as mammograms or those for prostate or lung cancer do not prevent cancer, but detect cancer earlier so that treatment can more effectively reduce mortality. However, screening colonoscopy can prevent cancer because if a polyp is found, it can be removed and prevent it from turning cancerous,” Dr. Mertens said.

“From a population perspective, we continue to make slow but steady progress to discontinue the use of tobacco and reduce alcohol consumption while obesity is going in the opposite direction. We are now seeing the price of obesity and an unhealthy diet in terms of increasing rates of colorectal cancer in younger people under 45. And, there is still a great deal of work to do on increasing physical activity which both improves cancer outcomes as well as impact- ing other conditions such as heart and vascular disease,” he added.

As for the future, the Baystate cancer specialist noted promising work that may play a major role in cancer identification and treatment, as well as areas that must be addressed in prevention.

“In addition to work on cancer causing genes, such as the BRCA1 and 2 genes that cause inherited breast and ovarian cancer syndrome, and genes that are associated with other inherited cancer syndromes, there is increasing research still in its infancy on infectious agents as causes of cancer. Scientific study in this area may offer interesting results in the next 10-15 years including clarifying the role of bacteria in our bowels - the gut microbiome -in cancer causation and management,” Dr. Mertens said.

More work also needs to be done to improve the quality of life for cancer patients and their families. He agrees with the World Health Organization’s assessment that effective health strategies, comprising community- and home-based care, are essential to provide pain relief and palliative care, which is treatment to relieve, rather than cure, symptoms and suffering caused by cancer.

“Cancer care has been revolutionized over the past 50 years, but our community and home care models have not kept pace with this rapid change. Care provider organizations and health insurance entities will have to make significant strides to modernize and remain relevant to patients and families facing complex care challenges,” Dr. Mertens said.

For more information on the Baystate Regional Cancer Program and the D’Amour Center for Cancer Care, visit baystatehealth.org /services/cancer.