New insights, treatments, tests in disease 'war'

Medical community is starting to believe less is more when it comes to cancer treatments 

More and more doctors and patients apparently are using less aggressive weapons to fight cancer these days.

Dr. Justin Bekelman

A story by Laurie McKinley in yesterday's Washington Post quotes Dr. Justin Bekelman, a radiation oncologist at the University of Pennsylvania, about the medical community's focus on the "war on cancer."

Historically, he says, that phrase "implied that more is better and decimation is desired."

McKinley's story contends, however, that the idea is "falling out of favor," not only because it "subtly blames patients" who die "but also because it doesn't capture a world of new biological insights, improved treatments and molecular tests that are transforming how cancer is treated."

According to Bekelman, "Knowing when not to treat" can be "great medicine" — because, the story charges, oncologists equipped with new tools and evidence can cut back on toxic and costly approaches likely do more harm than good.

Cancer, nevertheless, is not monolithic, the story indicates.

Rather, some cancers "need to be bludgeoned, but others can be treated with more tailored therapies or simply watched."

Although the latest mindset of "doing less in the face of danger" can be "emotionally difficult" for both patients and physicians, the article notes, proof that less is more has been frequently popping up lately, including a landmark clinical trial published in June that found more than "two-thirds of women with early-stage breast cancer can safely avoid chemotherapy." 

Not to mention the fact, according to the piece, that "men with early-stage, low-risk prostate cancer are rapidly embracing 'active surveillance' over surgery — and avoiding possible complications such as incontinence and sexual dysfunction," and that throat cancer caused by human papilloma virus, because it varies from other types of the disease, allows a cutback "in a brutal treatment regimen and [reduces] the risk of potentially devastating disfigurement."

The Post story also mentions the emergence of immunotherapy, usually less toxic than chemo, "as a first-line treatment for many patients," and cites a recent study showing that "people with advanced kidney cancer can skip surgery to have their kidneys removed and instead go right to drug treatment."

De-escalation isn't happening universally, however. 

McKinley contends that the "most common form of thyroid cancer, which poses little risk, is often still treated with unnecessary surgery, experts say. And some malignancies, such as pancreatic cancer, are so lethal that doctors are racing to find ways to ramp up treatment."

Details on trends and clinical trials in treatment can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.