A Year in Review: Reflections on Successes and Shortcomings
Cancer Therapy Advisor's oncology editor discusses advances in oncology in 2016.
The year of 2016 has seen the passing of both the Cancer Moonshot program and the Cures Act, both of which are likely to have profound effects on health care in the United States. But the expected repeal of the Affordable Care Act after the President-elect's inauguration has left the future of US health care unclear.
Nescience about future policy has not, however, slowed the progress oncologists continue to make for treating virulent diseases. Cancer is beginning to overtake heart disease as the leading cause of death in the Western world, and, though survivorship is increasing, it is vital that scientists and policy makers collaborate to continue to improve treatment.
In the past year the U.S. Food and Drug Administration (FDA) has approved nivolumab and ipilimumab for melanoma and pembrolizumab for non-small cell lung cancer. The FDA also issued an approval for sarcoma for the first time in over 40 years.
Despite clinical advancements for treatments of almost every type of cancer, however, cost of care, quality of life, and inconsistent treatment nationally remain major problems. That the former President, Jimmy Carter, is “cancer free” after being diagnosed with stage IV melanoma is certainly a triumph of modern oncology, but it's highly unlikely that all — or even most — patients diagnosed at the same disease stage have the same chance of long term survival. It's equally unlikely, furthermore, that the average patient will be able to afford the treatment that Mr Carter received (a problem that panelists discussing immunotherapy did not discuss at the 2016 Concordia Summit). The burden of care has even been linked to medication non-adherence, especially as more orally administered immunotherapies are approved.
Quality of life, particularly after surviving pediatric cancer, is a growing problem. Toxic therapies can cause lifelong health problems, including other cancers, and a growing body of literature discusses the best ways to prevent long term health problems that can result from cancer treatments.
To move towards a cure, oncologists must not only research to find new efficacious drugs, but to ensure that clinicians are aware of the almost constant treatment advancements in clinical oncology. Education — both of the general public and of clinicians — is therefore essential for a cure to be possible.
The burden of payments and the inability to receive financial assistance precludes effective cancer care as much as a drug's never being approved. Toxicity can ruin a patient's life, even if the disease is cured. And poor communication in the large and constantly changing world of oncology can leave some patients receiving obsolete care.
Drug approvals and clinical trials are an important part, but still only 1 part of a larger machine that must work as a whole to move towards a cure for cancer. Policy makers, oncologists, and biologists must cooperate so that cancer is not only clinically treatable, but so that it is accessible, that oncogenesis is better understood, and that policy and research are aligned to improve cancer treatment nationally.