The future of cancer treatment is being defined by buzzwords like precision medicine and targeted therapy. What these words indicate is that cancer treatment is becoming highly personalized, with each therapy tailored to the individual's specific disease and personal genetic makeup.
For the past 50 years, when someone was diagnosed with cancer, their disease was named and categorized by the location of the tumor in the body. For example, a solid tumor found in a lung was called lung cancer. However, researchers and doctors are starting to understand that lung tumors can be vastly different between two people and require very different treatments.
"We used to think cancers were the same, but there are cellular-level discrepancies between each patient's cancer," said Costanzo DiPerna, MD, MBA, senior director at Dignity Health Cancer Institute (DHCI) of Greater Sacramento and chief of thoracic surgery at Mercy Medical Group, a service of Dignity Health Medical Foundation. "Ways to diagnose, screen, and treat each person's cancer are becoming more complex and more tailored to each patient in an intimate, unique way."
With advances in technology and genomics, part of defining cancer for an individual now involves a genetic workup to understand the DNA of the tumor and predict how it might respond to specific treatments.
Armed with a genetic profile of the disease, doctors can recommend treatments that address what drives tumor growth or what's happening within the patient's body. Radiation is also more targeted, protecting more of the surrounding tissue and organs from damage. Newer chemotherapeutics target what has gone haywire at the cellular level, rather than being a blind swipe to kill cells the way earlier treatments were, and immunotherapy is an exciting area in progress that uses the body's own immune response to fight cancer.
Physicians have a larger educational role as well, Dr. DiPerna said. They must help patients understand what the data about their disease means and discuss their quality of life and outcome expectations. "Many patients still figure chemotherapy is their only treatment and that their quality of life will be poor during those sessions," he said. "Newer chemotherapies have fewer side effects and could offer better outcomes. There's a demand for oncologists to be well-versed in the management of cancer at the DNA level. Oncologists have to encourage their patients to be proactive. It's a give and take more than ever."
Another major shift in the past decade or two has been to not only treat the disease, but manage the entire experience of cancer. Cancer care now includes social workers, nurse navigators, psychologists, psychiatrists, nutritionists, chaplains, and other specialists to address the psychosocial aspects of a chronic disease. There's recognition that exercise and counseling also contribute to overall quality of life and aid in healing.
With this deeper understanding of the genetics of an individual disease, the future of cancer treatment also means more opportunities to prevent cancer or catch it at earlier stages. Even screening recommendations are becoming tailored based on a patient's risk profile, such as family history or environmental risk factors.
Prevention examines the hereditary and environmental factors leading to disease, and genetic counselors play an integral role in this aspect of cancer care. Laura Westbrook, a genetic counselor and program coordinator for genetic services at DHCI, said the counselor's role is to help determine a person's risk factors and predisposition for a certain type of cancer, which can then be used to develop targeted strategies. "A personalized risk assessment weighs family history, genetic testing, and lifestyle factors, like whether the person smokes or used hormone replacement therapy," Westbrook said. "Then we look at what we can do to prevent cancer, such as screenings, risk-reducing surgery, or medication."
Dr. DiPerna said cancer specialists use the information from the genetic counselors to help people sustain a prevention protocol, such as avoiding pollution or environmental exposures. In some cases, cancer can't be prevented, but having the risk assessment helps the individual, their caregiver, and the oncologist anticipate what's next when they're diagnosed.
With the vast amounts of information available, doctors and patients have much more of a partnership in care. You'll likely continue to have more choices and more information about your disease. DiPerna and Westbrook look forward to advances continuing in precision medicine and what that will offer patients.
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