Our topic for the next #LCSM Tweet Chat on Thursday, October 6, at 5 PM Pacific (8 PM Eastern) is “Cancer Cure vs. Chronic Disease: How Critical is the Difference?” The moderator for this chat is Dr. Jack West (@JackWestMD).
Curing cancer is among the most valued goals in the world, both on an individual and a more global basis, and it is really at the pinnacle of the “cancer moonshot” effort. But as we try to translate these goals into practice, and as I talk with my patients in the clinic, it’s clear that “cure” means different things to different people. For this week’s #LCSM chat, we’ll explore the different ways to think about the best outcomes we might achieve, and what we would be willing to do to achieve them.
To most people, the idea of a complete cure implies not only that the disease won’t limit survival or cause significant symptoms, but that we see no trace of it, often focusing on a rather arbitrary time line of 5 years. However, some slower processes may recur many years later. Is there a specific time you focus on as the definitive time that you consider as the target milestone?
Many patients diagnosed with a cancer that can be treated with surgery vs. an alternative way to manage it are highly motivated to “just get it out”, explaining that they have a certain level of sleep-depriving anxiety from knowing that their body harbors a cancer. That’s understandable, but as we develop treatments like targeted therapies and immunotherapy that can suppress and control a cancer for a long period, it raises the question of how much worse it really is to have a cancer that may be present, monitored and neutralized, for long enough to cause significant symptoms or shorten survival.
Our lab tests and our scans make it increasingly possible to detect tiny amounts of cancer, perhaps a nodule that measures 1-2 millimeters or a small amount of a cancerous gene’s DNA or a protein by-product of the cancer in the blood. Minimally invasive surgery or focused radiation make it possible to treat findings on scans that may have no symptoms and may not change survival – how valuable is it to have no evidence of disease in this situation? Similarly, we sometimes identify cancers that are so minimal and/or slow-growing that we rightly wonder whether the treatment may be worse than the disease, especially when it may progress over decades rather than months or years.
With these developments in mind, we will explore the following timely questions:
T1) What is your definition of a cure? How much more valuable is that than long-term control of suppressed cancer & same survival?
T2) Is there a specific milestone you focus on as defining point for cure & feel you wouldn’t worry about recurrence beyond that time?
T3) What is greatest appeal of seeing no evidence of disease (NED)? Less anxiety/fear of progression? No need for further therapy?
T4) Could you accept monitoring minimal disease by lab test or scans if it had a greater than 98% chance of not limiting survival & never causing symptoms?
These are questions for which we have no consensus, whether from patients, caregivers, physicians, or other health care providers. This means that everyone’s personal insight is extremely helpful, so please join moderator me at 8 PM Eastern, 5 PM Pacific on Thursday, 10/6 for what will be a thought-provoking, lively discussion. If you’re new to #LCSM Chat, please see this handy primer on participation.