The New York Times May 28, 2002 Expanding Horizons, and Expectations, in Cancer Care By LAWRENCE K. ALTMAN, M.D. ORLANDO, Fla., May 21 — New findings that excite cancer researchers often ring hollow to cancer patients. The reason is that the two groups have different expectations. For researchers, an exciting development may mean that a drug undergoing early trials delays the progress of an advanced cancer for an extra month or two in 30 percent of a small group of dying patients. For patients, an exciting development means that the new drug will provide extra years of life. Two very different perspectives, each perfectly understandable. So when the last of 3,000 reports was presented at the annual meeting of the American Society of Clinical Oncology here with no apparent major breakthroughs in any of the four most common forms of the disease — lung, breast, prostate and colorectal — few researchers were disappointed. While the gains reported were incremental, measured in percentage points and weeks of added survival, the experts said the gains could change the standard of medical practice for certain cancers. It was patients who were disappointed — and other interested parties, including the drug and biotechnology industries, their investors and members of the public, who, after all, may be cancer patients themselves someday. Many reasons exist for the gap in perspectives. One is that the various groups seek to communicate the gains in the most favorable light. Another reason lies in the changing nature of cancer research, which now encompasses a wider sphere than in decades past. As the horizons have expanded, so have expectations. Patients and their doctors want favorable news. Research has become big business. Entrepreneurs have high expectations. Taxpayers have heavily invested in seeking cures for cancer, the nation's second leading cause of death, behind heart disease, making the disease a hot issue. To justify budgets, politicians have urged officials of federal agencies to publicize new findings. And charities need to boast of progress to gain contributions. The various parties view scientific findings through different lenses. For patients fighting for each extra day of life, news of even small gains offers hope that they may be able to keep working and see their children and grandchildren grow up. Patient advocacy groups have sprung up to lobby to increase support for cancer and to influence how the money is spent. Cancer specialists treat sick patients, for whom standard therapies often fail. So the prospect of offering something new, even if it is just an incremental gain in improving symptoms or survival, can make doctors enthusiastic. Although doctors are trained to be objective, they can react as emotionally as patients on learning about slight progress. Also, doctors know that initial gains may be small, because clinical trials have to start with the sickest, hardest-to-treat patients. The hope is that after the trials establish a therapy's safety and effectiveness, the gains will be greater when it is used for patients at earlier stages of illness. Further, scientific meetings offer doctors a break from practice. Listening to reports that help decipher a mechanism in the cancer process can be intellectually stimulating. The news can raise hopes that the findings will eventually lead to new therapies. In recent years, the drug industry has come up with "smart bombs" that aim to destroy cancerous cells without harming normal ones. The drugs are designed to slow or jam growth signals in the cancerous cells. Occasionally, the industry has scored big hits like Herceptin for breast cancer and Gleevec for chronic myeloid leukemia and GIST, for a rare form of intestinal cancer. The drug and biotechnology industries want to market new drugs and therapies as fast as possible to recoup the big development costs. The industry boasts of significant advances to encourage doctors to prescribe their drugs and to encourage investors. Companies and leading cancer centers pay squadrons of public relations workers to flock around reporters to offer interviews with major researchers. So gains that seem merely incremental may disappoint industry executives and investment analysts. Politicians who promote programs to pay for cancer research in government laboratories and medical schools tend to promise that those programs will lead to cures. They become impatient when the gains are small. Yet research in cancer, as in other diseases, tends to move slowly. Gains reported at most of the oncology society's earlier meetings have been modest. The meetings allow doctors to put new findings in the context of older ones, to learn how they can better use drugs and to change the standard of practice when warranted. Part of the gap in expectations can be traced to communications. At one time, doctors were overly cautious in discussing developments. Now many lean in the other direction, selecting data that put new findings in the most favorable light and emphasize their statistical significance. Sometimes statistical flaws in reports are not immediately apparent at scientific meetings. Investigators may play down a new therapy's unwanted adverse effects. So when the oncologists go home, they have to weigh what is reported as statistically significant against what may be clinically significant in the care of patients. In communicating modest findings or commenting on developments in their field, some experts become enthusiastic, if not zealous. They speak in hyperbole, using phrases like "hitting a home run" and "a spectacular addition to the therapeutic armamentarium." "Depending on whom you speak to," said Dr. William Gradishar of Northwestern University, the chairman of the society's communications committee, "you would think the disease is being cured when it is not by any means." Then there is the potential for conflicts of interest. Many cancer investigators are allied with industry, and some become enthusiastic boosters of the drugs they are developing. Although researchers are asked to disclose such financial interests, it is easy to imagine that their objectivity may be compromised. Editors of medical journals have belatedly learned that some authors have not followed standard practice in writing their papers, but instead signed off on papers written by public relations firms. Many participants at these meetings are wined and dined at sumptuous buffets and receive gifts when they visit a company's exhibit in the convention centers. Satellite sessions, which are not official parts of the main meetings, are paid for with unrestricted educational grants from companies whose representatives often speak at the well-attended sessions. None of these problems mean that there was no good news to emerge from the oncologists' meeting. There were particularly promising reports involving new uses for old drugs. In one report that excited many oncologists, oxaliplatin, a drug long used by French doctors and not marketed here, showed promise in treating cancer of the colon and rectum. Dr. Larry Norton, the society's departing president and a breast cancer expert at the Memorial Sloan-Kettering Cancer Center in Manhattan, theorized that pulling old drugs off the shelf and combining them with other drugs might lead to substantial advances. But as Dr. Gradishar of Northwestern said, summing up the modest gains reported for "smart bomb" drugs and other new therapies, "Unfortunately, chemotherapy, surgery and radiation are not going to go away." Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.