Oncologists at Yale New Haven Health Greenwich Hospital recently hosted a panel on the future of cancer care, detailing what they considered to be the improving capability necessary in the face of a rising need for treatment.
“Since the inception of oncology as a distinct discipline of medicine in the 1960s, there have been three ways of treating cancer: surgery, radiation therapy and chemotherapy,”said Dr. M. Sung Lee, medical director of the Smilow Cancer Hospital Care Center in Greenwich. “Historically, these treatment modalities have been used in various combinations and sequences to treat cancer patients with the simple goals of improving the quality of patient life and longevity.”
Lee pointed to the past 20 years as a period of numerous advances in both oncology and medicine that have drastically improved outcomes for cancer patients. He highlighted the rise of minimally invasive and robotically aided surgery, immunotherapy where the body’s natural defenses are trained to effectively deliver treatment, and radio surgery where highly precise applications of energy can achieve results similar to surgery but with fewer side effects than some older forms of radiation therapy.
The emergence of new techniques has brought about additional specialization on the parts of doctors, Lee explained. In the past, simply being an oncologist was considered a narrow field, but as different cancers in disparate sections of the body can behave in drastically different ways it has seen the rise of the “tumor board,”a collection of specialists working together to create a holistic plan of care.
“One of the many things that I’ve learned in the 20 years of my practice is that every patient is unique in their own way,”Lee said. “And in order to make sure that we are delivering the latest and the best care, we need to tap into the collective knowledge and resources of all of our colleagues. The days of an oncologist by herself or himself trying to provide for the complex needs of our patients are long in the past. Our patients now live longer ”” they live better through this collaborative effort of all the different medical specialists and our supportive staff.”
Dr. Ian Krop, director of the clinic trials office and the chief clinical research officer at the Yale Cancer Center, discussed the need for continued clinical trials to continue the pace of progress that the field of oncology has seen in recent years.
“Cancer treatments are now dramatically better than they were only 20 years ago,”Krop said. “Back then almost all of the drugs we gave were chemotherapy, drugs essentially designed to kill any fast-growing cells. Those therapies are effective but because normal cells can also grow very quickly, such as blood cells or hair cells, these chemotherapies tend to have a substantial amount of side effects and cancers can become resistant.”
According to Krop, the major shift has come in targeting the forces within cancer cells which cause them to grow and become cancerous. Since they target only the operations of the mutation, other fast-growing cells are unharmed.
Krop also viewed the emergence of immunotherapy as a promising field of development that teaches the body to attack cancer cells on its own by using antibodies to create “guided missiles”that attach themselves only to cancer cells while delivering a chemotherapy drug payload.
“None of this development of new drugs would have happened without patients volunteering to participate in trials,”he said. “It’s a way to get access to the very latest treatment.”
Dr. Eric Winer, director of the Yale Cancer Center and physician-in-chief of the Smilow Cancer Network, discussed the increasingly holistic approach to care being taken by many oncologists, drawing on a broad range of expertise to provide truly multidisciplinary care. But more than involving additional doctors, he said “partnering with patients”is the cornerstone of clinical care and research.
“I think that’s what’s best for patients,”Winer added. “I actually think that’s what is best for doctors too, and it’s one of the ways we can protect ourselves from burnout, by feeling like our patients are our partners.”
In the future, Winer predicted increasing specialization combined with more highly targeted treatments and the emergence of health networks like Yale New Haven Health will make treatment increasingly convenient for patients ”” and some networks allow people to receive treatment closer to home instead of traveling hours to reach large cancer centers.
While some treatments require heavy equipment or specialized approaches that preclude home treatment, Winer said that as therapies become better targeted while producing fewer side-effects, new treatment environments will become available.
Those advancements are welcome news, said Dr. Barbara Ward, chief of surgery and director of the Greenwich Hospital Breast Center, who told the audience that the Office of Strategy Management, an internal thinktank for the Yale New Haven Health System focused on forecasting emerging health needs, made a concerning determination.
“They say in the next 10 years in the Greenwich-Stamford region nearly all cancer types show growth rates between 20% to 26%, with breast, gynecologic, and urologic cancers remaining the most prevalent in our region,”she said, adding these figures are higher than the rest of Connecticut which stands at 6% to 12% growth rates.
However, Ward noted that “it’s important to understand that prevalence is the total number of cases in an existing population. That includes patients that were diagnosed with cancer in the past and are surviving. So, it’s not completely bad to have a high prevalence if you’re alive and doing well but have had a history of breast cancer. At the same time, I think it got the system’s attention that in Greenwich specifically we are going to have increasing needs in the future.”
Ward allowed that the area’s unusually high numbers could in part be attributed to a population that is very proactive in testing and screening but stressed the need to maintain that culture.
“We realize we’re incredibly blessed to be living where we are right now with the way we’re screened,”she said. “And yet, why are we here tonight? We have a cancer problem. Connecticut again has a higher incidence of most cancers than in other parts of the country and our area is predicted to have a significant increased prevalence in the years ahead. As I mentioned this includes patients alive with cancer or a history of cancer, but they’ll need treatment and they’ll need follow up. We need to remain at the forefront of early detection and treatment.”
