According to Clifton Leaf, an American journalist and the editor-in-chief of Fortune magazine,  we are not winning the war on cancer but are actually losing horribly!
Leaf, who gave a talk in an advocacy session entitled “Why We Are Losing the War on Cancer,” last week, has been talking about this fact for the past few years, on stage and in his book entitled The Truth in Small Doses.
A decade ago, Leaf, a celebrated journalist and a cancer survivor himself, began to investigate why we had made such limited progress fighting this terrifying disease. The result is a gripping narrative that reveals why the public’s immense investment in research has been badly misspent, why scientists seldom collaborate and share their data, why new drugs are so expensive yet routinely fail, and why our best hope for progress—brilliant young scientists—are now abandoning the search for a cure.

A write-up on the book read:

“Through flowing prose Leaf delivers, alongside facts and data, stories on personalities involved in research, the fascinating process of solving an unusual and highly deadly cancer in Africa, and the heartbreaking realities of cancer treatment in children today. Leaf’s extensively investigated treatise will resonate with researchers and patients frustrated by the bureaucratic woes he delineates. Public policy makers, grant reviewers, and pharmaceutical researchers alike must consider Leaf’s indictment and proposed solutions” (Publishers Weekly). The Truth in Small Doses is that rare tale that will both outrage readers and inspire conversation and change.

 

How do we Define “Success” in the Global Fight against Cancer?

Unfortunately, success can be defined many ways depending on viewpoint.
Looking at 5-year relative survival rates from 1973-2013 in the SEER database (an American cancer registry), it would appear that we are doing much better across all cancer sites – survival rates appear to have significantly improved for all cancer types.

  • However, what this fails to capture is that this is primarily driven by increasing diagnosis of early-stage cancers
  • If we diagnose cancers earlier, the 5-year CSS rates improve as the population gets enriched by patients at earlier stages
  • However, patients with later stages, the 5-year CSS has not really changed that much
  • Lead-time bias is often not accounted for

Looking at cancer drug development, this is even more sobering. In the past 10 years, the numbers of drugs in development in the US have skyrocketed 5-fold (399 in 2009, but 1120 in 2018). But, as seen in a pivotal paper by Scannel et al. (Nature Reviews drug discovery 2012), the number of drugs developed per US billion dollars spent has decreased from ~80 in 1950 to <1 in 2010! Our return on investment has drastically decreased!
That, in turn, has translated into rising healthcare costs.
This diagram depicts how the monthly cost of cancer drugs has now exceeded the monthly median household income – which means that cancer healthcare is no longer affordable!
These are very sobering statistics and a sign of the wrong direction that our healthcare is heading towards.
What about cancer diagnoses and incidence? Are we making any impact?
The predicted global incidence and cancer deaths will continue to increase through the next 20-30 years, as predicted. In addition, the burden of cancer has continued to grow over the past few decades.
Leaf’s final set of points was a focus on the “most important metric that no one looks at” – person-years of life lost due to cancer.
Over the past 15-years, the average life-years lost per person dying of cancer has increased, especially for those patients with childhood cancers, but also for a few other major malignancies.
Compared to other causes of death, cancer has actually worsened – it is still the top cause, but the average number of years lost has increased to 9.4 from 8.3. Other causes have actually improved, including heart disease.
This was a very sobering talk regarding the overall cancer burden and progress we have made as a field.
Perhaps we need a change of focus – rather than extremely expensive treatments for a small population of patients, we need better strategies for prevention and interventions that can impact a larger swathe of the population!
 

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