22 April 2021

What a wonderful world

Cancer

It really wasn’t all that long ago that the words “cancer treatment” were synonymous with disfiguring surgeries, completely debilitating chemotherapy and side-effect-ridden radiotherapy – when patients really had to make a choice whether the treatment was worth it for the small chance of more time.

How far we’ve come.

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

The results were incredible. A significant number of patients who had been riddled with bony mets and whose prognoses were measured in days rather than months, quite literally were able, after treatment, to get up off their death bed and be 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 witnesses to a miracle.

It wasn’t a miracle of course. And 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 effective treatment for someone with metastatic melanoma. The first time he could offer some hope.

I was reminded this moment in time when a study showing improvements in cancer survival rates was published in 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.

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 statistics, 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 this is truly the wow factor in medicine. The 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 not really changed the face of therapy for many cancers, including colon, lung and ovary which were part of this study.

I am not an oncologist. I am a GP 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 are having an amazing impact.

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

New treatments are targeted and clever. Really, really clever. 

What’s more, they have changed we talk about 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 we need to be so grateful for the real advances being made and being able to offer so many patients hope.

Just like that specialist from many years ago, I have that sense of awe and enthusiasm. It is a real privilege to be involved 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.

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