President Biden, returning to an important health issue with which he has deep, tragic personal connection, has reprised a White House call for a “moon shot” campaign to keep the public and the medical establishment focused on finding even more effective ways to battle cancer, a leading killer of Americans.
Biden wants the nation to halve its cancer death rate. But aside from using the bully pulpit of the presidency and pushing people in his administration to promote and oversee cancer-fighting proposals, he did not discuss new federal money for research or treatment.
The president, who lost a son to brain cancer, may have provided a fine public service by reminding Americans to see their doctors and not postpone what can be valuable health screenings.
The constraints on advances in cancer treatment, alas, may have been underscored not only by questions raised about the Biden’s cancer statements but also by unrelated media coverage of Pennsylvania researchers’ findings about their use of an experimental treatment for a type of leukemia. As the New York Times reported of the novel use of a gene therapy known as CAR T:
“The treatment involves removing T cells, white blood cells that fight viruses, from a patient’s blood and genetically engineering them to fight cancer. Then the modified cells are infused back into a patient’s circulation.”
The Pennsylvania experts employed this therapy in a clinical trial involving a handful of patients with chronic lymphocytic leukemia, finding this a decade later:
“[T]he CAR T treatment made the cancer vanish in two out of the three patients in that early trial. All had chronic lymphocytic leukemia. The big surprise, though, was that even though the cancer seemed to be long gone, the CAR T cells remained in the patients’ bloodstreams, circulating as sentinels.”
As the newspaper details how the treatment worked for patient Doug Olson, 75, and living in California:
“In the case of chronic lymphocytic leukemia, the type Mr. Olson had, the cancer involved B cells, the antibody-forming cells of the immune system. A patient’s T cells are taught to recognize B cells and destroy them. The result, if the treatment succeeded, would be to destroy every B cell in the body. Patients would be left with no B cells. But also no cancer.”
To its credit, the New York Times, except when quoting the doctor-researchers involved, largely avoided describing the patients’ change with a word dreaded in rigorous medical-scientific research and hyped too much these days: cure. The newspaper said the leukemia “vanished.” But the extensive, buoyant coverage by the newspaper and, for example, the Associated Press (which did use that darned word) might give savvy readers pause.
Sure, the results are promising, especially given the long-term scrutiny of CAR T use. But dig into both the New York Times and AP articles and consider this other information, please. The newspaper reported that patient Olson, while not dealing with a life-threatening form of leukemia, must receive “regular infusions of antibodies in the form of immunoglobulin infusions.” This treatment, which typically must occur in doctors’ offices, clinics, or hospitals is not cheap, nor is it without its own side effects.
And then there is this from the newspaper:
“The [CAR T] therapy has helped many with blood cancers and has proved particularly effective in patients with acute leukemias and other blood cancers. By contrast, those like Mr. Olson with chronic lymphocytic leukemia, also known as CLL, have seen less success. Among those with that cancer, about a third to a fifth go into remission with CAR T therapy, but many whose cancers disappear later relapse. ‘The question is not only why some patients relapse or are resistant to therapy but why are some patients cured?’ said Dr. John F. DiPersio, chief of the division of oncology at Washington University in St. Louis, who was not involved in the study. The CAR T treatment has also caused serious side effects in some patients like high fevers, comas, dangerously low blood pressure and even death — although in most patients the alarming symptoms resolve. It has not yet worked in people with the solid tumors found in conditions like breast and prostate cancer.”
The AP delays until nearly the end of its article — transmitted to a huge audience of the global news service — to report this of CAR T cancer treatment:
“Even in blood cancers, there are challenges. The therapies are expensive, running into the hundreds of thousands of dollars just for the drugs. And there’s the risk of significant side effects, including an immune overreaction called ‘cytokine release syndrome’ and nervous system-related problems such as brain swelling.”
Good to know. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford efficient, excellent health care. This has become an ordeal due to the skyrocketing uncertainty, complexity, and cost of treatments and prescription medications, too many of which turn out to be dangerous drugs. Medical science has, indeed, made impressive progress in fighting cancer. As CNN reported:
“The overall cancer death rate dropped by about a third (32%) from its peak in 1991 to 2019, from about 215 deaths for every 100,000 people to about 146, averting about 3.5 million deaths during that time, according to the data [from the American Cancer Society]. Most of that decline can be attributed to a drop in mortality among lung cancer patients. The [society] projects that there will be about 1.9 million new cancer diagnoses and more than 609,000 cancer deaths in the United States in 2022, including about 350 deaths per day from lung cancer, the leading cause of cancer death.”
The nation has seen big declines in many types of cancer, not just due to treatment advances but also because of other changes, such as big reductions in cigarette smoking, exposure to home and workplace toxins, and improved approaches to health challenges like obesity. As the New York Times reported of Biden’s call, for example, for increased cancer screening:
“More screenings are not the answer — the only cancers for which screening has indisputably lowered the death rate are colon and cervical. Death rates for other cancers, like breast, have fallen, but a large part of the drop, if not all of it, is because of improved treatment, said Donald A. Berry, a biostatistician at the University of Texas M.D. Anderson Cancer Center who has spent decades studying these issues. ‘Everybody loves early detection, but it comes with harms,’ he said — principally, the harm of finding and treating tumors that do not need to be treated because they are innocuous. ‘The harms we know, but the benefits of screening are very uncertain,’ he said.”
As for burgeoning but still experimental therapies, including new drugs and novel treatments like CAR T, cancer experts themselves concede that these can have promising and limited outcomes, with medications especially promoted on the basis not of their improvement on patients’ quality of life or longevity but on their short-term capacity to shrink a tumor or address symptoms. Many of the novel therapies also come at bankrupting cost, an issue so serious that specialists call the concern the “financial toxicity” in cancer care.
We have much work to do to battle cancer, and here’s hoping that the nation can achieve Biden’s ambitious goals while also being realistic about the effectiveness, ready access, cost, and safety of treatments to do so.