In the May 27 edition of the Opinionator from the New York Times is a piece entitled, “In Medicine, Falling for Fake Innovation.” Regardless of your political persuasion, I would urge readers who are interested in the future of healthcare (or more specifically, cancer care) in the U.S. to read this article by Ezekiel Emanuel: http://opinionator.blogs.nytimes.com/2012/05/27/in-medicine-falling-for-fake-innovation/?ref=health. When it comes to innovation in cancer care, there is marketing (the hype) and there are results or data (the reality). Quite often, the gap is wide. Unfortunately, more often than not, the public can’t easily access information to find the difference.
A few shining examples of hardware and software come to mind as technological advances in modern society. Taking mobile phones to the next level, so called “smartphones” (Blackberry, Android, iPhone, etc) improved the efficiency with which millions of people send and receive information. Facebook, Twitter, and other social media sites link people to friends, family, and the rest of PC-connected (or smartphone-connected) humanity in a way that was never before possible. Where are these types of technological innovations in the field of cancer care?
The standard options for cancer treatment include surgery, radiation therapy, and systemic therapy (the most well known of which is chemotherapy). Many oncologists would argue that cancer care has been dramatically improved by technological advances in all three fields over the past 20 years. Examples from the three disciplines include:
- Laparoscopy for colon cancer surgery: Randomized trials show that laparoscopic removal of colon cancer is at least as effective as previous “open” surgery from an “anti-cancer” standpoint (if not more so), but with less side effects: http://www.ncbi.nlm.nih.gov/pubmed/19071061 , http://www.ncbi.nlm.nih.gov/pubmed/12103285. While proponents of robotic surgery make similar claims, we await actual data in this regard (see Emanuel article above or prior blog post at thecancermd.com).
- Stereotactic body radiation therapy (SBRT) for early stage lung cancer: Patients who are medically unfit to undergo lung cancer surgery to remove small lung cancers can be treated with a technologically advanced form of radiation therapy delivery that uses multiple high dose beams focused on a small area over 3 treatments with a >90% chance of complete tumor control: http://www.ncbi.nlm.nih.gov/pubmed/20233825
- Herceptin for breast cancer: This systemic anti-cancer treatment (generic name trastuzumab) is targeted against breast cancers that overexpress the her2 gene/protein. Randomized clinical trials have shown that patients with these type of breast cancers who are treated with Herceptin have improved survival and quality of life over those treated with standard chemotherapy alone: http://www.ncbi.nlm.nih.gov/pubmed/11248153, http://www.ncbi.nlm.nih.gov/pubmed/12118024
These three examples represent major technological advances in cancer care. There are other treatments with clear survival or quality of life benefits for patients that have been proven in randomized controlled clinical trials. Differentiating these innovative “breakthrough” treatments from other new treatments that do not have clear benefits over the current standard is the challenge.
Dozens of new anti-cancer treatments come to market each year. Virtually every one is touted to oncologists by manufacturers and marketers as “practice-changing,” with promises of dramatic improvements for patients’ lives. However, technological advances in medicine must be held to a higher standard than smartphones and social media sites. We can’t afford to let market forces play out unbounded by scientific rigor and constraints.
New medicines or technologies that work in unique and potentially helpful ways are interesting. It’s when they’re proven to be better than the current standard of care via rigorous clinical trials that they become truly innovative!
- Patrick Maguire MD