Friday Feedback: Does 'Cancer Report' Improve Practice?
Participants were contacted by email and asked to respond to the following question: How clinically relevant are these types of findings to your practice?Friday Feedback is a feature that presents a sampling of opinions solicited by MedPage Today in response to a healthcare issue, clinical controversy, or new finding reported that week. This week, the topic is the latest results from the American Cancer Society's annual review of cancer statistics called the Cancer Report.
The participants this week:
Jan Buckner, MD, chair, Department of Oncology Mayo Clinic Cancer Center
Ross Camidge, MD, PhD, director of thoracic oncology clinical program, University of Colorado Cancer Center in Denver
Cliff Hudis, MD, chief, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center
Gary Lyman, MD, PhD, co-director of the Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center in Seattle
Jeffrey Meyerhardt, MD, MPH, clinical director of the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute
Edwin Posadas, MD, medical director of the Urologic Oncology Program at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute in Los Angeles
Dan Raz, MD, co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope in Duarte, Calif.
In Practice -- Changes
Mikkael Sekeres, MD, director, Leukemia Program at Cleveland Clinic
Jan Buckner, MD: "The ACS annual review of cancer statistics helps clinicians understand long-term trends in cancer outcomes relevant to prevention, screening, and treatment. To the extent that these trends are reflected in individual practices, they highlight areas for improved prevention and screening strategies, as well as likely long-term staffing needs."
Gary Lyman, MD, PhD: "The impact on my practice will be primarily to inform patients and encourage them on the progress that we seem to be making in clinical outcomes across several common cancers and cancer in general, i.e., with appropriate lifestyle and other modifications, appropriate screening, and high quality cancer care, the outlook for many patients with cancer is looking better and better."
Mikkael Sekeres, MD: "My practice focuses on patients who have leukemia or myelodysplastic syndromes. I have noticed a big jump in the number of leukemia cases diagnosed each year, and anticipate we will be busier as a result. This has major implications for chemotherapy drug supply, as one of the key chemotherapeutics to treat acute leukemias -- daunorubicin -- has been in short supply or entirely unavailable for large parts of the past year."
Jeffrey Meyerhardt, MD, MPH: "Awareness of factors that can decrease risk of cancer as well as lead to earlier diagnosis hopefully is taking hold and should continue to be discussed with patients both in the primary care and specialist clinics, including exercise, healthy diet, avoiding/stopping smoking, and screening for certain cancers."
In Practice -- No Change
Edwin Posadas, MD: "The annual statistics put forward by the American Cancer Society do bear import in my practice both for the research and standard clinical portions. The updates provide important information on global trends in cancer over time as well as a sense for what cancers are the more emerging problems. These data help clinicians assure patients that progress is being made and provide hope to many for longer life and, in many cases, improved quality."
Dan Raz, MD: "While this doesn't specifically alter clinical practice, it highlights the importance of tobacco control and cancer screening in preventing cancer deaths. Importantly, lung cancer-related deaths can be substantially reduced with lung cancer screening with low dose radiation CT scanning, which was recently recommended by the U.S. Preventive Services Task Force for high-risk current and former smokers. CT screening has the potential to turn lung cancer into a disease that we can cure sometimes to a disease that we can cure most of the time."
There Are Concerns
Ross Camidge, MD, PhD: "As a practicing oncologist with a full clinic -- whether absolutely fewer patients are getting some cancers doesn't affect our day to day practice as we are sought out by the patients who do have cancer. In terms of the death rate -- this is made up of two major factors. First, those who are cured from early stage cancers where more (and more accurate) early detection and better adjuvant therapies that alter the cure rate have a major impact. Alternatively, when a new intervention that prolongs control of advanced cancer but does not alter the cure rate is introduced we could sometimes be seeing a postponement of the death rate from the cancer (which is still a big deal and highly desirable). Any overall trend down over many years is more likely to reflect the former. A sudden change may reflect the latter. The latter is certainly happening, and we can see it in the clinic every day."
Meyerhardt: "Of concern, however, are that some of the more difficult to treat cancers have not altered death rates, including lung, pancreatic, brain cancer, and melanoma. Despite some advances in treatment for these diseases, improvement in survival is still limited for many patients, and much more research is needed to impact the natural history of these and other cancers."
Sekeres: "That 585,000 people are dying from cancer in the U.S. each year should be a call to action for more research into novel therapies and therapy combinations, and increased education about not denying therapies to cancer patients simply because of advanced age or other medical conditions."
Posadas: "It is disturbing to see the lack of movement in bladder and pancreas, or even worse, to see the increase in bile duct cancers."
But Reasons To Be Encouraged
Lyman: "Could we be doing better and could the downward slope be steeper? I suspect so, but it is difficult to know. We are still faced with disparities issues related to access, quality of treatment, etc., and still face major and increasing cost challenges. It is essential that we do a better job defining the real 'value' of cancer diagnostic, staging, and treatment options and find ways to effectively provide the most valuable options to our patients while steering away from those that do not work and only drive up costs and often cause harm."
Cliff Hudis, MD: "We are reassured by the reduction in deaths from common cancers despite a growing and aging population. With improved control of tobacco and modification of other lifestyle risks -- like diet and exercise -- we could further reduce risk. At the same time, the benefits of recent and remarkable advances in our understanding of the biology of cancer are yielding ever more effective and safe treatments that will only accelerate the favorable trends we are already witnessing. The key to this, of course, is to maintain and augment our investments in science and health."
Meyerhardt: "The recent estimated cancer statistics for 2014 continue to provide some encouragement in the overall progress of cancer treatment and care in the U.S. with a decrease in death rate of 1.4% to 1.8% per year and nearly 20% decline for the past 2 decades."
Sekeres: "The decline in cancer mortality reported by the American Cancer Society is extremely exciting, and a tribute to increased public awareness of and a heightened public comfort level in discussing cancer and participating in effective cancer screening strategies. It is no time to rest on our laurels, however. Much of this progress can be attributed to identifying earlier stages of cancer; less to the effectiveness of our available therapies."
Lyman: "Clearly, the estimates from ACS are encouraging and supportive of the trends that we have seen over the past decades and more. It certainly says that we are doing something -- and perhaps a lot -- 'right.' Having said that, it is more difficult to determine how many of the improvements indicated relate to improved cancer treatments, better supportive care, earlier diagnosis, prevention efforts, or even stage migration due to reclassification of disease categories and stage. I do believe the trends, if not the absolute numbers, are real and important for clinicians and patients as well as for policymakers to indicate that we are moving forward. I believe that we are making meaningful progress against cancer that impacts directly on patients and their families."
Posadas: "It is encouraging to see decreases in incidence and mortality in the more common cancers such as lung, prostate, breast, and colon. Even within cancers, the data provide insights into how we are doing. For me, the annual incidence and mortality data provide information on the relative importance of prostate cancer as well as a sense of what impact our new therapies are having on overall mortality. In diseases such as prostate and kidney cancer, where a large number of new agents are now being approved and developed, I think it is critical to see if we are truly 'moving the mark' or if our efforts are not well expended."
Camidge: "Our own lung cancer program here has survival rates for advanced lung cancer nearly four times the national average -- often driven by sophisticated profiling of the cancer to match it to specific targeted therapies -- not curing the disease in these people but turning it into a more chronic condition."
Raz: "These findings on the numbers of cancer deaths show an encouraging decline in the top cancer killers, specifically lung, colon, and breast cancer. Lung cancer, which accounts for more deaths than breast, colon, prostate, and pancreatic cancers combined, has the largest impact on these statistics. The reasons for the slow decline in lung cancer deaths is unequivocally related to tobacco control. We have the opportunity to further reduce deaths from lung cancer with even tighter tobacco control measures such as increasing cigarette taxes, which have been shown to lead to increased quit rates."