• read more about SMART

    TECHNOLOGY

    SMART Cancer Center: Safer, Better, Cheaper.

    • Arc techniques minimize second cancers
    • 6 MV LINAC provides maximum sparing of critical organs
    • 3D Treatment significantly reduces costs
  • Educate yourself

    EDUCATION

    Patient Education through Physician Education.

    • Franklin County Cancer Committee
    • Franklin County Breast Care Team
    • American Cancer Society Resource Center
 

Celebrating Survival Focusing on Quality

Not long ago, a diagnosis of cancer was most often a death sentence. These days, most of the people diagnosed with cancer are cured. Success in the fight against cancer has been nothing short of remarkable. That very success creates our new challenge: maximizing the quality of life after treatment.

Last year, the American Cancer Society marked a milestone in the treatment of cancer. In its annual fundraising campaign, the organizers pointed out that we are now curing “2 out of 3”cases. As evidence, they published the National Cancer Institute’s survival tables, which demonstrated that the 5-year relative survival in the most recently available data was 68%.

That number is already outdated. In order to be absolutely certain that they are providing accurate analysis, the NCI report detailing 5-year survival must be based upon patients treated at least 5 years ago. In fact, the 68% survival was actually based on patients treated between 1999 and 2006. The midpoint of that time-frame is 2002, which means that the average patient in the study sample was actually treated 10 years ago.

Tremendous progress has been made in cancer care over the past 5 decades. There is no reason to believe that progress came to a halt a decade ago. It is more likely that progress has followed roughly the same trajectory in the most recent decade as it did in the previous 50 years. If we project the historical trend on the historical data (see graph), it reveals that the 5-year relative survival of a patient diagnosed with cancer in 2012 is likely to be 75% — or 3 out of 4!

As those of us who are striving to design and support the cancer center that will meet the needs of our community well into the future, we must realize that the 5-year survival rate in the year 2020 is likely to be 80% — or 4 out of 5!

In this context, it is no longer sufficient to think about cancer treatment in terms of survival alone. The old approach of “cure at all cost” must give way to a more thoughtful consideration that places a premium on the quality of survival after treatment. If 80% of the cancer patients are going to be cured, then 80% will be destined to live the rest of their normal life expectancy with the consequences and complications of the treatment.

As cancer specialists, we are not waiting for the future, we are already preparing for it. We are already making significant adjustments in our traditional approach to this disease. In breast cancer surgery for instance, these adjustments take the form of performing a less damaging form of lymph node biopsy rather than the traditional axillary dissection, because the smaller procedure provides all the benefit of the more aggressive surgery, but avoids the most serious complications, such as arm swelling and decreased range of shoulder motion.

Range of motion in the shoulder may seem a secondary consideration when dealing with something as serious as cancer, but when you consider that many of these women will be swinging a tennis racket or a golf club for decades afterward, such considerations take on a pleasant new significance.

The new generation of chemotherapy drugs is not only more effective, but far less toxic, both in the sort run and the long run. Targeted therapy based on the genetic characteristics of an individual’s cancer is in its infancy. The pipeline of new, targeted therapies is set to explode in the coming decade.

In Radiation Oncology, the most significant improvement during the last two decades has been our ability to focus the lethal effects of the radiation more precisely on the cancerous target, while sparing the surrounding, sensitive normal structures. Much of the progress in the next decade will take the form of developing even safer methods of radiation delivery to minimize the most serious long-term complications of radiation.

Today, the Cancer Care Team working in Franklin County is working diligently to integrate the newest, safest techniques into the care of each individual patient. This effort is our way of honoring those who have brought us this far.