I Will Survive Early Detection, Cutting-edge Therapies Combine to Lower Cancer Mortality Rates

Cancer is never a happy story. But the trends in oncology in the past decade have been decidedly optimistic.Since the inception of the Healthcare News 10 years ago, the overriding theme that has emerged from cancer care is this: while most cancers aren’t technically curable, doctors are beating them back to the point where the average patient can expect to live far longer than individuals with similar diagnoses in decades past.

“It’s not a death sentence anymore,” said Dr. Yvonne Pola, director of the Sr. Caritas Cancer Center at Mercy Medical Center. “Today, people come in for treatments and go on with their daily lives.”

In fact, in the National Cancer Institute’s recent Cancer Trends Progress Report, while incidence is rising for some cancers (e.g., melanoma, leukemia, and thyroid) and falling for others (e.g., breast, colon, lung, prostate), mortality rates are almost universally falling — only liver and pancreatic cancers show rising death rates, and esophageal cancer mortality is stable; in every other subset, it’s falling, in some cases dramatically.

“For the first time in history, we’ve seen a decrease in mortality rates, and that applies to the three most common cancers — breast, lung, and colon,” said Dr. Zubeena Mateen, director of Hematology/Oncology at Holyoke Medical Center. “Part of it has been new treatments, and coming up with treatments that are less toxic to the patient, which has constantly led to an overall improvement in quality of life.”

Those treatments encompass everything from better anti-nausea medications to get through chemotherapy to more targeted forms of surgery that take aim at cancerous tissue while leaving healthy tissue relatively unharmed.

The other side of the story, said Dr. Wilson Mertens, medical director of Cancer Services for Baystate Health, is a rising emphasis on early detection. Of particular note has been increased use of screening tools such as mammograms to detect breast cancer and prostate-specific antigen (PSA) screenings for prostate cancer — tests that, nonetheless, have stirred some debate among medical and governmental bodies as to whether they’re being overused.

“There has been a lot of noise over whether these are effective or not,” Mertens said, “but when you look at both breast cancer and prostate cancer, someone has to explain to me the drop in death rates year after year — breast cancer since 1990, prostate cancer since 1996. It’s not because cancer decided to take a holiday, but because treatments have become more effective, and because of early detection and application of that effective therapy.”

For this 10th anniversary issue, the Healthcare News examines some of these positive developments in cancer care and how they’re bringing new hope to people facing one of the most feared — and common — diagnoses in all of medicine.

Medical Home

While diagnosis and treatment of cancer has improved nationwide, the landscape for cancer care has changed quite literally in Western Mass. as well. In 2004, Baystate Health opened the D’Amour Center for Cancer Care, one of a string of construction projects Baystate has undertaken on North Main Street in Springfield. Meanwhile, Mercy Medical Center opened its St. Caritas Cancer Center later that year, and other hospitals have expanded their cancer programs to some degree.

The D’Amour Center brought under one roof a network of cancer services that had been located at various sites and, in so doing, made life easier for patients and improved teamwork among providers. Exam rooms have been configured to allow multiple specialists to see a patient during each visit, which allows them to coordinate opinions and develop a treatment plan with a minimum of inconvenience to the person receiving care.

“The fundamental philosophy of the building is to appreciate that cancer is a team sport. One cancer specialist treating a malignancy in a patient is long gone; we need to facilitate a robust team and create a medical home for the cancer patient,” Mertens said. “I also think having this cancer center has drawn more interest from physicians whose practices involve cancer patients.”

Design elements were chosen to be calming; small but important details include TV sets in waiting areas that can be heard only with headphones, decreasing the noise level; and a café that serves mostly cold foods in an effort to reduce aromas that could trigger nausea in patients receiving treatment nearby.

Mercy took similar care designing the patient spaces in the Caritas Center. Designers considered both aesthetics — diffused light, cool colors, natural lines — and functionality; staff areas are out in the open so patients can find help right away, and much of the hardware of cutting-edge scanning and treatment equipment is subtly camouflaged behind strategic walls and cabinet doors, among other considerations.

“It’s really changed and become very patient-friendly,” Pola said of the new style of cancer center. “In the old days of cancer treatment, it was more or less a bed, a chair, and that feeling of being in a hospital. We don’t have that feeling anymore.”

Still, a comforting space isn’t worth much if not backed up by that aforementioned state-of-the-art technology. “I’ve been working in the field since 1984,” Pola said, “and we have seen leaps in technological advances in radiation.”

When the two Springfield-based cancer centers were opening two decades later, they touted the use of intensity-modulated radiation therapy (IMRT), a computerized radiation method that can pinpoint a cancerous area more accurately and reduce the spread of radiation to healthy tissue; it was developed as an enhancement of 3-D conformal radiation therapy, the industry standard for radiation treatment.

Today, that has been surpassed by image-guided radiotherapy (IGRT), which allows the radiologist to actually see the tumor during the procedure — helpful because tumors can move between treatments — making the delivery of radiation an even more accurate science.

“The biggest change is image-guided radiotherapy, and it’s done with CT scanners that actually image the tumor during treatment,” Pola said. “It has made radiation very site-specific and has helped keep patients very healthy while reducing the radiation to healthy tissue.”

And the innovations keep coming, like robotic surgery that has already revolutionized surgery to treat prostate cancer (see story, page 15) and other conditions. But no matter how effective the treatment, it’s still best to catch cancer early on.

To Screen or Not to Screen?

That’s why the U.S. Preventive Services Task Force, which was tasked with issuing new government guidelines for mammograms, caused a stir last year when it concluded that getting screened for breast cancer in one’s 40s causes more harm than good, triggering too many false alarms and unneeded biopsies without substantially boosting women’s odds of surviving the disease.

The American Cancer Society disagreed, reinforcing its recommendation for yearly screenings starting at age 40. Mertens said he understands the concern about treating too many patients, “but we shouldn’t lose track of the fact that we started this journey to try to reduce cancer mortality, and that mission is being accomplished.”

Indeed, the statistics don’t lie: the 10-year survival rate after a breast-cancer diagnosis has risen from less than 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in the early 1970s to 77{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} today. Similarly, the 10-year survival rate for prostate cancer — another disease that has been subject to knocks about overscreening — has soared from 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} in the early 1970s to about 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} today. Catching the disease earlier, screening proponents say, is a significant factor.

For those being treated for cancer, the therapies are now so targeted to the tumor and away from healthy tissue that the patient stays healthier overall. Mateen cited the emerging field of small-molecule therapy, with treatments — often administered in pill form — that block the spread of cancer by interfering with specific molecules involved in tumor growth.

“They don’t have that many said effects,” she explained. “You can keep your quality of life and go about your business because it doesn’t have all the detrimental effects” of other traditional treatments, including chemotherapy and radiation.

It’s just one more way scientists and doctors are giving cancer patients their lives back, even as they battle a dreaded disease.

“We’ve moved cancer care from an inpatient setting to an outpatient setting, and perhaps that’s the biggest advance of all,” Pola said. “Even in the ’70s and ’80s, cancer was treated like a death sentence. Now, it’s treated like any chronic condition. You might have it a long time, or it might be cured or go into remission. And then you become a survivor.”

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