New way of looking at the numbers shows positive progress in reducing cancer mortality rates

[caption id="attachment_20322" align="alignleft" width="420"] Breast cancer[/caption]

Since the enactment of the in 1971 the National Cancer Act was enacted.  Since then the United States has spent many billions of dollars researching and treating the disease, and the newest research offers real evidence that we are winning the war against cancer.  The future, however, is hopeful given the progress to date, as observed in the research recently published in the Journal of Clinical Oncology.

The lead researcher, Samir Soneji, PhD, assistant professor for Geisel School of Medicine at Dartmouth and the Dartmouth Institute for Health Policy and Clinical Practice, a member of Norris Cotton Cancer Center, has this to say, “As fewer and fewer people die from heart disease, stroke, and accidents, more and more people are alive long enough to be at risk of developing and dying from cancer.”

Mortality rates from heart disease, cerebrovascular disease, and accidents  declined 62 percent, 73 percent, and 38 percent, respectively between 1970 and 2008 . In the same period, cancer mortality rates declined just 12 percent.

Researchers examined these differences and used a metric to look at the burden of cancer mortality, which is called the years of life lost due to cancer and is the consequences of how much longer we are expected to live if we don’t have cancer.  Then the researchers looked at that burden of cancer mortality and assessed how advancements in cancer care had directly improved that burden and how advancements in the care of other diseases might have impacted the burden negatively.

Because progress in the treatment of other diseases other than cancer have decreased mortality rates, people are living longer, which means an increase proportionately in the years of life lost from cancer.

“We estimate how the years of life lost from cancer are directly affected by cancer mortality and indirectly affected by increased cancer incidence because of greater longevity due to improvements in primary prevention, detection, and treatment of other disease,” said Soneji.   Using this approach to the problem researchers were able to measure the progress made in the burden of cancer mortality.

As one example, lung cancer mortality rates between 1985 and 2005 significantly reduced the burden of lung cancer mortality.  But as mortality rates decreased in other areas of disease management and life expectancy increased, some of these changes partially offset the progress seen in the longevity of patients.  Yet smoking definitely reduced the burden of cancer mortality.

As researchers examined life expectancy increases brought about by reducing mortality rates from diseases other than cancer, it allowed them to see the real progress actually made in the treatment of cancer, observing that other measures that had been used had not accounted for these factors. “Our approach reveals more accurately the aggregate contribution of cancer prevention, screening, and treatment on progress against cancer,” said Soneji.

To date, survival time and mortality rates have been the leading population-level measures of cancer burden. These measures assess the effect of prevention, screening, and treatment on cancer, but they fail to account for changes in other-cause mortality rates.

This is good news in supporting the hope of winning the war against cancer.

John Hopkins doctor underlines quality of life in treatment of braincancer.

[caption id="attachment_4309" align="alignleft" width="256" caption="Cerebral lobes of the brain"][/caption]

Carol Forsloff - This idea of living longer, but not living very well with brain cancer
worries Alfredo Quinones, M.D., so he stresses quality not just quantity
of life and a special multi-faceted approach.



Quinones, who is Director of Brain Tumor Surgery at John Hopkins University


Quinones has expertise in looking at the various aspects of brain cancer and 
"minimizing collateral damage," the euphemistic way of saying trying to
reduce the elements of the disease so that people can be as comfortable
as possible.


“Brain cancer is sort of the bastard child of cancer,”says Quinones.
“There are about 3,000 new cases a month of the very malignant cancer,
like Senator

Ted Kennedy had.” Thousands more people develop secondary brain tumors –
offshoots of cancer that originate elsewhere, say in the lungs, and
somehow find their way to the brain. “Once cancers get to the brain,
people tend to give up on these patients. But there are so many simple
things we can do,” he says, to have an immediate result on quality of
life, and possibly prolong survival. For example, simply treating
depression and controlling blood sugar levels can make a big difference.


Educating the medical community about how small things can make a big
difference in the quality of life for cancer patients is something
Quinones says is very important.  That's because cancer has so many
facets.


Today, the prognosis for someone diagnosed with an aggressive brain
tumor is devastating; the average survival is just 15 months. “Can we
make it 20 months,”says Quinones. “Then, can we make it 40 months?Ten
years?” But – and this is huge – can those be good years? “Or are those
going to be patients who have absolutely no memory, their brains
potentially fried by radiation, severely impaired. We have to find ways
to minimize the collateral damage that we do through surgery and
adjuvant treatment.” The length of survival is 
meaningless, he adds, “if you’re bedridden, you don’t recognize your loved ones, if you have no memory.”


Quinones is convinced that research on the multiple aspects of brain
cancer and looking at the quality of life as well as the length of life
in the treatment of the disease will be the key to changing how patients
are treated.


This is not rocket science,” he says, “but no one asks,especially with
brain cancer patients, how the family is doing. How are the caregivers
coping? This is honestly part of the big picture; quality of life is not independent.
We are building that infrastructure for long-term follow-up.” Quinones has been concerned for a longtime about the complications of brain cancer and that while doctors look at prolonging the life of their patients, he says it is also important to look at that quality of life that should go with it.