What has been labeled as the ultimate biography of cancer, Barak Goodman’s documentary Cancer: The Emperor of All Maladies, based on the book by Siddharta Mukherjee, aired in March and is causing quite the buzz within the oncology community. The amazing biopic covers a wide range of topics of cancer ranging from early treatments from 1900s, advancements in surgery, targeted therapies, lobbying efforts in Congress and activism, changes in philosophical approaches towards treatments, the ups and downs of breakthroughs, and novel new treatments. As a healthcare technology company, with a mission to support clinicians’ delivery of quality cancer care, we want to weigh in on the #cancerFilm conversation, and provide to our followers a summary of what we believe to be the 5 crucial takeaways from the documentary. While we highly recommend you invest the time to watch Emperors, if you are among the many of us who don’t have 6 hours to spare, then this article will come in handy!
Takeaway 1 – Targeting Genetic Mutations
The first milestone in cancer treatment was the introduction of the first chemotherapy, aminopterin, in 1940 by Sidney Farber. His discovery led to the development and use of other chemotherapeutic agents, either singly or, more effectively, in combination for treating childhood and adult malignancies. But perhaps the greater discovery was not until the 1970s, when the concept of targeting somatic mutations within cancer cells changed mindsets for treatment approaches. It wasn’t however until the 1990s that this hypothesis was proven true with breakthrough drugs Herceptin and Gleevec that target specific genetic mutations in breast cancer and CML, respectively.
Takeaway 2 – Big Data
In the era before “big data” was coined, epidemiologists discovered that smoking causes the vast majority of lung cancer cases and sun exposure causes melanoma. In the 1990s, the federal government funded the Human Genome Project, and then more specifically The Cancer Genome Atlas project to catalogue genetic mutations responsible for cancer, using genome sequencing and bioinformatics. Today, numerous commercial enterprises are seeking to unlock data from the Electronic Medical Records (EMRs) and other sources to understand aggregate trends that impact cancer survival and quality of life following a drug’s FDA approval so that an individual’s treatment can be personalized based on aggregate trends, even beyond a patient’s genetic mutations. Patient-reported data is also receiving attention in the scientific community. While patient-reported outcomes (PRO) has long been a significant consideration for drug approval by the FDA, today PRO data are increasingly captured as part of the clinical assessment on an individual basis to improve a patient’s quality of life and aggregated for treatment comparative effectiveness studies.
Still an issue in oncology is the desperate need for clinical trial participation and subsequent data to advance our understanding of the benefit of new therapies relative to those currently used.
Takeaway 3 Immunotherapies
After many decades of research and roller coaster rides with the possibility of finding the next breakthrough that will lead us to a potential “cure”, many oncology researchers are excited about the recent developments in using our own immune systems to fight cancer via next-generation immunotherapies. As one researcher mentions in the film, the cancer cell is “evolution at hyperspeed,” incessantly powerful and adaptable. Cancer ultimately evades even revolutionary targeted therapies that target the originally identified genetic mutations. The hypothesis behind immunotherapies is that as strong as cancer’s hyper speed evolution is, the human immune system may be equally strong and resilient. The filmmakers strive not to oversell immunotherapy, suggesting that to date, no treatment armamentarium has been able to ultimately defeat cancer.
Immune-based cancer treatments are under investigation for metastatic melanoma (with approved indications), metastatic NSCLC (with approved indications), breast, renal cell, and bladder cancers, to name a few.
Takeaway 4 Palliative Medicine
Emperor gave significant attention explaining the ups and downs of cancer care and research and our limitations in curing patients with metastatic disease. We’re glad they touched on palliative care. The widespread practice of palliative medicine represents a positive shift in respecting the dignity and quality of life for patients with metastatic disease. We also commend the standards that have been set forth in many new quality certification programs that require written documentation of provider-patient conversations regarding patient goals of care and the endorsement of early palliative care for patients with advanced disease.
Takeaway 5 Prevention and Early Detection
We must be careful to not delude ourselves into believing targeted therapies and immunotherapies will be a panacea for cancer treatment. There must be more investment – publicly and privately – in preventing cancer. As “The Emperor of All Maladies” notes, more than 50 percent of cancer incidences worldwide are thought to be preventable —through smoking cessation, obesity prevention, limited sun exposure, appropriate genetic screenings for high-risk breast cancer patients, Hepatitis B and Human Papillomavirus Virus immunuzations, treatment of H. pylori infection, good primary care, the avoidance of risky health behaviors, and the avoidance of known carcinogens to name a few. Perhaps this is the most powerful take-away of all.
Where does Carevive Health fit in the equation? We are now seeing rapid transformational change with the advancement and adoption of technology in cancer care. Many companies are pioneering technologies to evaluate genetic mutations of tumor samples, pathways/clinical decision support technology, data analytics, to name a few solutions.
Our product provides many solutions for cancer centers. “It makes me proud to think that the Carevive Health platform touches so many of these key take-aways,” states Madelyn Trupkin Herzfeld, CEO of Carevive Health. “Our landmark product, the survivorship care plan, gives cancer survivors and their primary care providers the surveillance plan and information they need to prevent or detect early a cancer recurrence. Our symptom assessment and management tools offer the cancer care team patient-reported data on patients’ symptom experience and offers the relevant evidence-based guidelines to help the clinician and the patient manage such symptoms to improve quality of life during active treatment. Ultimately, our goal is to mine data on symptom trends and PROs and the impact of prescribed interventions to drive better guidelines and improve patient quality of life. Finally, we have been developing a clinical trial accrual platform to assess patient eligibility for clinical trials and educate patients about such opportunities so that we have a better understanding of what the future holds for cancer care.”
How about you? Do you agree with us? What were your takeaways from the film? We’d love to hear from you below.