From Mark Levine, the Doc with the Pink Tights

I usually write about breast cancer, research and the progress that has been made. The underlying tone tends to be very positive. The tone of today’s article is different, but the intention is to stimulate thought.

Recently, I was driving to work listening to Matt Galloway on CBC’s “the Current.” My ears perked up when I heard the person being interviewed, Dr. Azra Raza, talk about cancer treatments and their impact on patients.

She stated that treatments had not changed much over the last 25 years and the mainstays were still surgery, radiation, and chemotherapy, which have significant side effects. Later, I listened to the podcast and I am glad I did (CBC The Current). I also am reading her recently published book.

Dr. Raza is an oncologist at Columbia University. She is the author of The First Cell: And the Human Cost of Pursuing Cancer to the Last. Dr. Raza is of the same vintage as me and has been practicing oncology for more than 30 years. Her main area of clinical practice is acute leukemia and related bone marrow disorders.

She states that patients who present with acute myelogenous leukemia (AML) are treated with the same two chemotherapy drugs now as was done 30 years ago. She finds this very frustrating given the many advances in technology and research that have advanced our understanding of the cancer cell at the gene and molecular level.

It is my impression that Dr. Raza is looking at the cancer world with her cup half full. I say this without being judgemental. She has many years experience in caring for cancer patients. In addition, her husband, who was also an oncologist, died of AML and she was his caregiver. The book has several important messages.

While there has been much progress in cancer research, there is much more to be done. Dr. Raza is particularly critical of basic science research in the laboratory, where new potential anti-cancer drugs are often studied in mouse models.

Dr. Raza argues that this is not a good way to find new drugs because what happens in a mouse is not applicable to humans. She proposes that cancer research should use the latest technology to identify cancer at its inception; i.e. “the first cell.” Then, the cancer burden would be very low and amenable to eradication.

In fact, this kind of research is ongoing. Large cohorts (thousands) of healthy people are being followed and their genes can be studied from a blood sample. Some of these people will develop cancer. Then it will be possible to look for a relationship between the presence of an abnormal gene and the development of cancer. However, we will have to wait a number of years for these results.

Dr. Raza has a message on the treatment of patients with metastatic cancer. This is done through her heartfelt and compassionate stories of patients dying of cancer.
Although researchers and oncologists often talk about cure, 90 percent of patients with metastatic cancer die of their cancer. For these patients, Dr. Raza argues about the importance of quality of life over quantity of life. Many patients will choose treatments with substantial toxicity for a few-week prolongation of life, but patients are not always informed that the benefits of treatment are modest, at best. Oncologists tend to “chase after the last cancer cell,” she notes.

Dr. Raza reminds oncologists of one of the primary tenets of medicine: “primum non nocere – first do no harm.” My feeling is that this book is mandatory reading for young oncologists.