How Far Have We Come With Cancer Research And Treatment?

Today is the final day of WBUR's special series, "This Moment in Cancer."  From targeted genetic drugs to immunotherapies, we've been exploring why Boston researchers are feeling a renewed optimism about new research and discoveries that are revolutionizing the way we treat the disease. We've also explored how that optimism is tempered by the stark challenges that cancer patients still face.

Carey Goldberg, host of WBUR's CommonHealth, which tweets @commonhealth.

Dr. Monica Bertagnolli, chief of the Division of Surgical Oncology at the Dana-Farber/Brigham and Women’s Cancer Center, which tweets @BrighamWomens.

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MC: Welcome back to radio Boston. I'm Meghna Chakrabarti. Today is the final day of WBUR's special series, This Moment in Cancer. From targeted genetic drugs to immunotherapies, we've been exploring why Boston researchers are feeling a renewed optimism about new research and discoveries that are revolutionizing the way we treat the disease. We've also explored how that optimism is tempered by the stark challenges that cancer patients still face. Here are some of the voices you've heard:

'The progress that we've seen has been so dramatic in so many cases that I think we can safely project ahead that we have turned the corner.'

'The last few years have seen an explosion in scientific breakthroughs in technologies that we can now apply to cancer. And a lot of other diseases. So there is no better time to do drug discovery than today.'`

'The immunotherapy saved my life. There's no doubt about it.'

'Some of the medications we give, you'll read the adverse side effects, or reasons that we would stop a certain study that a patient's on, and it's death.'

'One of the things cancer patients get a lot of is: 'Oh you're so strong, you're so resilient' and you just want to be like: 'You have no idea.'

'At BMC, when they come to us, their cancer diagnosis is often not their biggest problem.'

'Immediately when she was diagnosed, I had to stop working. Nothing is a guarantee at this point that came to any finances. I will do whatever I have to do to make sure that she stays alive.'

'I wish science was a little bit more advanced. I know what's going to happen, it's just the clock is not perfect for me.'

MC: We learned so much this week. But we imagine that there are so many more questions out there. So we want to hear from you and we want to hear your questions, your thoughts. Have you experienced this revolution in cancer research? What was it like? Are you excited by the progress and maybe simultaneously even worried about bigger disparities? Patients and family members, health care professionals. What is 'This Moment in Cancer' like for you?  We're going to hear from a physician who does some significant cancer research in just a moment. But first let me bring in Carey Goldberg, who is host of WBUR's CommonHealth blog. She has been reporting on This Moment In Cancer for us all week, in fact for quite some time. So, Carey, you've been immersed in this how would you sum it all up?

CG: Well, Meghna, you know I'm not usually a complainer but I have to say that it's hard to wrap your arms around cancer as a topic, and to try to simplify it enough that it fits into one story, or even one series, as you could hear in that montage that we just listened to. It's just so complex and so variable and it shoots off in so many different directions. And my one consolation is that I'm not alone in this. When former Vice President Biden was here recently talking about his Cancer Moonshot, he talked about how cancer is probably the hardest topic he's ever tackled:

'For the first time in my career someone gave me an assignment in an area that I know less about than my staff. I'm not being facetious. This is a daunting, daunting area.'

MC: So Carey, I take your point, but I also note that you didn't actually answer my question. How would you sum up This Moment in Cancer?

CG: What I would say is: What prompted this series was this sort of impressionistic sense that the mood in the cancer field has shifted, even just in the last couple of three years. That even though 600,000 Americans a year are still dying from cancer, and we mustn't lose sight of that fact, and there's a long, long way to go — there's also this sense of optimism, of progress, that the field hasn't had in a really long time, and maybe ever. And certainly the Obama White House Cancer Moonshot is a reflection of that.

I think the expression of that change in mood that has most stuck in my mind from my reporting on this series was something I heard from Todd Golub, the Scientific Director of the Broad Institute of MIT and Harvard. He said that for the first time, the problem of cancer is looking tractable:

'One can see a roadmap for what's needed over the decades ahead. It's not infinitely complex. It's really complex and hard and that's why we're not going to solve the problem tomorrow. But you can get your hands around it now.'

So to me, to hear something like that from a really careful, and I would say, very 'reality based' researcher who does not hype things — in fact you know researchers are very careful not to hype things because they don't want to raise false hopes — it's just very striking.

MC: So I've got a couple more questions for you but before we get to those, I do want to bring in the voice of someone who's in this field right now. She's Dr. Monica Bertagnolli, she's chief of the division of surgical oncology at the Dana-Farber Brigham and Women's Cancer Cancer Center and also the incoming president for the American Society of Clinical Oncology. Dr. Bertagnolli, welcome to Radio Boston.

MB: Thank you. Delighted to be here.

MC: It's great to have you. So reflect on what you heard Carey just say, that there is optimism of a kind that she hasn't felt or sensed before in in your community of researchers.

MB: Oh, definitely. You know so much has come out of the dedication to understanding the biology of cancer, so many new insights, and these new insights now have real therapies that are linked to them, that are working very well in real patients. So the issue is not that there's nothing new, and that there's nothing new that's working. The main issue now is: how do we use these, how do we improve on them, so that they work for everybody. And and how do we use the tools we have for an individual patient sitting in front of us, which is the big mystery and level of complexity.

MC: So let me ask you: what is the difference in terms of how you practice as a physician between how you approach treating a cancer patient now from what it was a decade ago?

MB: We have options. And we have more people on the team. I think even a decade ago we still recognized that there were many different ways to treat cancers and that patients needed individual therapy specific for them. But now there are so many more people joining that team, so many more experts. We have the traditional role of the surgeon, the medical oncologist who administers chemotherapy, the radiation therapist. But now we also have molecular biologists, we have pathologists, who are absolutely central to deciding what happens to a patient — just a whole big broader team.

MC: Well, we are at the tail end of WBUR's special series This Moment in Cancer and we would love to take your thoughts or questions or stories about your cancer treatment, or family member's, or even if you're a researcher, about how treating cancer is different than it has been before. Want to take a quick call here. Kayla is calling from Brookline. You're on the air.

Kayla: Hi. I really appreciate what you've been talking about all week. Very important. I think something gets lost in the ongoing conversation about cancer. I'm a 33 year old Hodgkins lymphoma survivor. Recently, just within the last year, I'm cancer free. But what I've noticed is that survival is just the beginning, for some — which is lucky. But the conversation about what cancer survivors and their loved ones and family continue to deal with, even after you had treatment and treatment is successful. I guess it's is something I wanted to inject into the conversation.

MC: Kayla, first of all, let me say that we are so delighted to hear that you're cancer free. Just congratulations on that, and thank you for your call and for your thoughts. Dr. Bertagnolli, reflect on that.

MB: So wonderful to hear that things have gone so well so far for you. There are about 14 million cancer survivors in the United States right now. It is a whole very large, very special population that has unique needs and we are just beginning now to understand how to address the needs of these patients. They have higher risk of cancer, they have more toxicities from their treatments, and some of these things are lifelong. So it's a very active area of research. It's a very active area of concern for many of the big professional organizations.

MC: So Carey, you had mentioned this earlier in the week, about how there also may be a change in terms of thinking that cancer may be able to become a disease that's more managed like a chronic disease than how we consider it currently. What does that mean for patients?

CG: Although these are actually two separate issues. So Kayla is actually a survivor, but then for people with advanced cancer that isn't actually curable, more and more people talk about the goal is to manage it like HIV, for example. You take combination therapy and you have an open-ended prognosis for how long it could last. That's a really big goal in the field now, I think.

MB: I was shaking my head because our big goal is to cure people, you know, to make it go away and never come back and never hurt anyone again and have it not be part of their reality. And unfortunately, that can be difficult if not impossible. And when it's not possible, then the job is to make life the best it can possibly be, and that's where the focus needs to be, certainly, when when cure is not an option.

MC: Let's take another call here. Lucy is calling from the Back Bay. You're on the air, Lucy.

Lucy: Hi. Thank you for taking my call. I just want to applaud your efforts. This series has been incredible and I especially appreciate you addressing the financial crisis that cancer brings to families, because so often when you think about cancer, you think about research and the incredible care teams —  especially in Boston, that we have, and our beautiful facilities, and that's what people think about when they think of cancer. But there's a whole other side. There's a reality that patients have to go home and how do they maintain a home? How do they afford a home? How do they heat their home? How do they afford a car? And that is the harsh reality that a lot of patients are embarrassed to talk about, or think it's just them, but it's having a direct effect on their chance to access care to adhere to their treatment. And it's directly affecting their chance of beating cancer. And I just wanted to applaud your efforts for bringing that to light this week.

MC: Lucy, thank you so much for your call, because I think this is an extraordinarily important point when we think about the totality of what treatment means for cancer today. Dr. Bertagnolli, how often does this become become part of what you as a physician think about when you're working with patients?

MB: There's no part of someone's life that cancer doesn't touch, when they have that diagnosis. Their relationships, their family, their children, their work, and their economic status, and what they think about every single day when they get up in the morning. So we physicians have got to be aware of that, and participate in that as part of helping patients with their cancer journey. And you know, we're not that good at it, that's the problem.

MC: We had a conversation about this just yesterday because our guest asked the question, 'Where does care and treatment really end when you're thinking about the whole patient, and how well equipped are hospitals to provide the entire universe of support?'

MB: I'll tell you where we get our best help: it's other patients. We are so lucky that we have patients and patient advocates who reach out to other people who have this same issue who can really relate to the experience. They help us figure out what we can do better and organize programs for cancer patients through the treatment. And also, it speaks to the survivorship question too, because one of the other big things we see is when we do succeed — making that switch over into a life of a cancer survivor as opposed to a cancer patient is something that the patients themselves are really teaching us how to help.

CG: And I would just throw in that we will be doing more cancer stories throughout the year, and one of the stories I'm dying to do is cancer and work and how difficult it is to keep working or have protection. As I understand it, being treated for cancer is not considered a disability, you don't really have protection against being laid off, for example if your company is small and it can't afford to replace you. So there are all kinds of cancer and work questions we'd like to get at.

MC: Yeah. In the last couple of minutes that we have I'd love to hear from both of you where you think this  fast pace of change is going to go to next because in the course of the series this week we heard about exciting new immunotherapies, about targeted therapies, that really look for specific genetic markers in individual tumor types. There was also a story about a computer at the Broad Institute that has DNA data from 10000 patients and is going to track the progress of their cancer. So that can provide additional power in terms of doctors trying to figure out how to treat folks. Where might we be headed next here?

MB: So I hope very much we're headed into that community of the data revolution, and that we really can look at a patient in our clinic and say: because of our access to data, because of our access to sharing across the entire treatment and research community, I know what has happened to people in your circumstances, and I have a better idea now because of that shared data experience how we can help you best. We've been so siloed and so selfish, all of us, in our sharing of the experience, and our patients have been telling us for decades, we want you to do this. So we need to listen to them. I think that is probably the biggest thing that's going to transform our ability to care for people in the short term.

CG: But for that you need the patients to stand up and say, 'I want you to share my data with each other,' right? And that's a piece of the Cancer Moonshot the former vice president had been pushing as well. People just have to share, it's what the patients want.