27 September 2019

Let’s not forget the progress we are making

Chronic Disease Clinical

Years ago I attended a talk being given by one of Sydney’s leading oncologists. He was presenting his experience with a new biologic which was being trialled in patients with advanced metastatic melanoma.

The results were incredible. He showed patients who were riddled with the aggressive cancer. Whose bone and CT scans appeared peppered with the  malignancy and had prognoses that were measured in days rather than months.

A significant number of these patients had quite literally responded to this treatment to the point that they had got up off their death bed and had been discharged from hospital. And the difference in their scans had you questioning whether they were images from the same patient.

While the details of this trial have long since disappeared from my grey matter, I will never forget this specialist’s enthusiasm and sense of awe. It was as though we were all being allowed to be witnesses to a miracle.

It wasn’t a miracle, of course. While there were many cases of amazing response to this treatment, in the majority of patients the cancer recurred as the tumour cells mutated, working out a way to bypass the biologic treatment. But it was start.

As the specialist said, in his 30 years as an oncologist this was the first time he was able to offer some potentially useful treatment for someone with advanced melanoma. The first time he could offer some hope.

I was reminded of this talk and this moment in time when I read a recent study published in the Lancet Oncology. It was this massive analysis of data from cancer registries from seven high income countries around the world, including Australia.

Basically the researchers looked at cancers from seven sites (oesophagus, stomach, colon, rectum, pancreas, lung and ovary) and compared the one- and five-year survival rates between 1995 and 2014.

As you might expect, net survival had increased over this time for all cancer types (yes, even pancreas) and in all countries, but what is truly inspirational is just how well Australia rates in terms of our cancer treatments and how well we continue to improve.

We’re not just upping the poisons – the new treatments are targeted and clever.

Compared with these six other countries (Canada, Denmark, Ireland, New Zealand, Norway and the UK) Australia has the best five-year survival rates for cancers of the oesophagus, stomach, colon (where the rate is now almost 71%!), rectum and pancreas in patients. And for lung cancer, we’re only second to Canada by a fraction of a percentage point and second only to Norway for ovarian cancer (can’t think why Norway would be best at treating ovarian cancer).

Looking at the stats, it appears we’ve always been at the top in terms of cancer treatment (in terms of these countries at least) and we’ve continued to improve over the last 20 years.

And if you’re starting to suspect this is all just feeding my competitive spirit – you are, in part, right. But the reality is these are real lives being saved. This is truly the wow factor in medicine.

This study included almost four million cases of cancer. When the researchers say Australia’s five-year survival for lung cancer has improved from 13.3% to 21.4% over 20 years we’re talking about thousands of people now living who would not have been. And in places such as the UK, these percentage point improvements can mean hundreds of thousands of lives.

Of course, it’s unlikely to be all due to new treatments. Better screening, imaging, testing and earlier diagnosis will all have played a part, but no-one could argue the new biologics have really changed the face of therapy for many cancers including colon, lung and ovary which were part of this study.

And even in my little consulting room, a world away from the oncological infusions, treatments with unpronounceable names and schedules of testing, monitoring, markers and PET scans – these phenomenal inroads in cancer therapy is having an amazing impact.

Right at this very moment I have at least six patients who would have been dead courtesy of their cancer had it not been for the new treatments. Even had they developed their cancer as little as five years ago, it is very unlikely they would now still be coming to my surgery. Two lung, two breast, one ovarian and one metastatic melanoma. And they’re not hanging on to life like shipwreck victims, they are well. They are  enjoying life, visiting people, partying and planning.

We’re not just upping the poisons – the new treatments are targeted and clever. Really, really clever.

What’s more, they have changed how we talk cancer with our patients. More and more (depending on the cancer) we can discuss it in terms of a chronic disease rather than the death sentence it once was.

I know we have a long way to go. Five-year survival rates of 14.6% for pancreatic cancer and 21.4% for lung cancer are far from perfect, but I am so grateful for the real advances being made and being able to offer many patients hope.

Just like that specialist from many years ago, I have that sense of awe and enthusiasm. We are so fortunate to be working in such a rewarding profession, at such an incredible time, in such a progressive country, with such phenomenal scientists. It’s easy to forget that sometimes.

Lancet Oncol 2019 http://dx.doi.org/10.1016/S1470-2045(19)30456-5