My Valentine's Wish for 2010

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My birthday is on the 11th, my mom's is on the 12th, my brother's is on the 13th and my father's is on the 14th -- all in different months. Since my dad's birthday is in February, my Valentine's Day reflections are for him.

At M. D. Anderson we're always focused on doing the very best for our patients. Ingrained in this notion of providing the "best" possible care is feeling unsatisfied when our treatment doesn't routinely produce the outcome we strive for -- cure of disease with outstanding quality of life and function in survivorship.

Because we're unsatisfied, we strive for better care through research and by rapidly and skillfully applying new advances in cancer medicine to the care of our patients. How do we sort out the most important new advances in cancer care from those that are less important or more uncertain? Here are some categories that come to mind:

Category A -- advances where some new, proof-of-principle in science is demonstrated. A breakthrough in scientific terms.

Category B -- advances that have major impact on lives or patterns of care, either due to the large number of affected patients or the large magnitude of change in the outcome or pattern of care.

Category C -- advances that are generally encouraging signs of progress. This is where most advances would be categorized, in my opinion. These are findings that affect fewer patients, influence fewer life-years or produce generally less dramatic changes. Some of this category's advances are of greater interest to the average non-physician because they address topics of broad interest or shared experience, or because there are business implications.

An example of a Category A advance, in my mind, is the work with PARP inhibitors (such as BSI-201) for selected patients with breast cancer. This represents a new category of treatment for a very difficult-to-treat subset of this common disease. This was a plenary session presentation at the 2010 annual meeting of the American Society of Clinical Oncology (ASCO), which reflects the scientific importance of this particular advance.

On the more positive side in Category B is the finding that testing tumors of patients with adenocarcinoma of the lung for specific mutations is likely to guide the best choice of treatment. It also was demonstrated this year that physician-patient communication near end of life is associated with patient choices that lead to improved end-of-life care quality and value.  

Some Category B level "advances" represent disappointing, albeit important news. For example, findings from the SELECT trial reported this year demonstrated that vitamin E and selenium do not prevent prostate cancer. We also learned that PSA screening does not effectively save lives in the way that we had hoped. Finally, we learned that the expensive monoclonal antibody bevacizumab -- while effective as part of the regimen treating advanced colon cancer -- is not actually useful as part of a strategy to prevent recurrence of colon cancer once it's been removed.

Ironically, feelings about that news was somewhat mixed for oncologists. On one hand, oncologists always want to see positive findings about new therapies. But importantly, we all want to know the truth about what really works and what does not. Many specialists also noted that overall health care expenses associated with a positive finding on this particular study may have created some real dilemmas.

With Valentine's Day approaching and so many loved ones (living and deceased) on my mind, I can't help but dream of new horizons. Like so many others, my heart has suffered losses attributable to cancer.

So what needs to be done to create a world in which more category A and B (high-impact) findings are produced, where the bulk of the advances are no longer stacked up in Category C (lower impact)? The cancer research world needs a better engine and more fuel.

The "engine" is the clinical research infrastructure, and that is an old and inefficient engine that needs to be fundamentally reformed. The "fuel" is the funding, and that fuel is necessary for any engine to run.

With expected large increases in the relative impact of cancer on the nation and its health and finances, the time for heartfelt focus on fueling up a fixed engine is now upon us.

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