Cancer breakthroughs won’t help you if your doctor isn’t using them
Ours was a chance meeting. But it likely made all the difference. He looked trim, fit and vigorous despite his 80 years. He was a member of the Rotary Club. I was the invited speaker, there to discuss how the Frederick National Laboratory, where I work, reduces suffering from cancer, HIV/AIDS and contagions like malaria, Ebola and the coronavirus.
Everyone in the audience knew him. He was at ease with them. The Rotarians’ custom is for attendees to share their stories of service and gratitude. He rose to speak.
His story shocked the audience and left them in an awkward silence. He said this might be his last meeting. After a six-year lung cancer remission, his tumor had come back. And now it was metastatic.
He felt fine, but his doctor said he would die within six months. The man confided that he had a long and fulfilling life with a loving family. He thanked everyone for their fellowship and concern and bid them a heartfelt goodbye.
As the sole oncologist in the room, I was stunned by what he said. No doctor knows how long a patient will live. But I knew about trailblazing work in lung cancer immunotherapy and precision cancer medicine, which improve the quality and length of survival after a lung cancer diagnosis. Perhaps this man had not been told of these groundbreaking discoveries.
Shortly after he spoke I was called to the podium. My speech cited advances against cancer and other diseases. I reviewed the remarkable responses of lung cancer patients whose tumors had a specific RAS oncoprotein mutation. New treatments for this mutation produced seemingly miraculous recoveries.
After my talk this cancer patient came up to me and asked if any of these treatments might help him. I asked if his doctor told him about the breakthroughs of immunotherapy or precision medicine. He said, “No, what’s that?”
This man’s story is not rare. It is just one example of the lag between advances in medical science and their adoption by care providers. This is the gap that implementation science seeks to bridge.
We must get evidence-based best practices and policies into routine practice sooner. Otherwise, patients won’t benefit.
This gentleman reached out to me after the meeting. I referred him to the Frederick National Laboratory’s oncology team for consultation.
No one is cured just by a published drug discovery in a scientific journal, no matter its prominence. It takes an astonishingly long time — about 17 years total — before many doctors can write a prescription for an innovative treatment. This needs to change.
It takes 12 or more years to go from a candidate drug discovery to completing laboratory, animal and human clinical trial testing. Then Food and Drug Administration approval is needed. It is no wonder fewer than 1 in 20 cancer drugs successfully completes this process. Once the FDA approves, it will take another five years or so for the new drug to find its way into common medical practice.
This final and essential implementation phase needs to be shorter. Otherwise each of us, our family, friends and community will not reap the full rewards of advances in biomedical science. This gap in knowledge is what we helped the Rotarian overcome.
He had his tumor analyzed for what is known as an “actionable mutation,” one that can be affected by a drug. The good news: His lung cancer had a cancer-specific mutation for which there are treatments with major clinical benefits. This man is likely to be aided by this treatment.
This is an archetype of how modern cancer medicine gives genuine hope to cancer victims. But innovations cannot help patients if their care providers are unaware. If it were not for our fluke meeting, this cancer patient would have been left to go home and get his affairs in order. We must do better than this.
Implementation science takes what we now know and makes a difference in the lives of those who are dealing with cancer today. The National Cancer Institute is making such efforts through the Cancer MoonshotSM initiative. There are powerful tools at hand to help disseminate this vital knowledge: artificial intelligence, peer networks and other measures influence how physicians adopt new drugs.
Cancer is not an abstract problem. We all have a stake in combating it. Few of us will go through life without facing the anguish of cancer ourselves or among our close friends or family. That’s reason enough to avoid every barrier to tackling this scourge. Accelerating the implementation of current cancer knowledge is a good place to start.