Cancer as a Chronic Illness?

Edition: April 2003 - Vol 11 Number 04
Article#: 1513
Author: Repertoire

Americans have come to accept some diseases – such as diabetes and heart disease – as chronic illnesses, something to live and deal with. Why not cancer?

In a recent article in The Wall Street Journal (“Why Curing Your Cancer May Not Be the Best Idea,” Feb. 11, 2003), oncologists question why cancer patients can’t come to view their diseases just as diabetics do – that is, serious and life-threatening, but not an immediate death sentence. Just as diabetics or heart patients spend years or decades taking pills or insulin, watching their diet, exercising regularly, etc., so perhaps should cancer patients stop counting on a miracle cure and instead gear themselves up for the long haul.

“Instead of winning the war [against cancer], many in the cancer community now think it’s possible – perhaps even desirable – to simply achieve a détente,” says the newspaper report.

“People say, ‘When is cancer going to be cured?’ But that implies that it’s either cure or nothing,” Paul A. Bunn Jr., president of the American Society of Clinical Oncology and director of the University of Colorado Cancer Center, is quoted as saying. “That isn’t the paradigm – it’s not all or nothing. We’re going to have a lot more agents ... that allow people to live with the cancer, not die from it, or at least die much later from it.”

This new attitude toward cancer treatment appears to be catching on among providers, says the report. Doctors and patients are more willing to take a long-term-view that they are treating a chronic illness. By foregoing extraordinary and toxic treatments, they leave their options open for other treatments that can prolong the patient’s life.

“Everyone goes for the home run,” says Deborah Armstrong, M.D., an ovarian-cancer specialist at the Johns Hopkins Kimmel Cancer Center in Baltimore. “But people are going to get burned out in a very short period of time. If you really push the toxicity of treatments, you burn bridges. You have treatments that are effective, but you can’t give it to [patients] because ... you pushed them too hard with the chemo.”

To be sure, some cancers are now considered curable, such as certain forms of lymphoma, childhood leukemia, and breast and testicular cancer. More cures are no doubt forthcoming. But, according to the report, “patients need to be aware that until that end goal is reached, they may live longer by managing their disease rather than trying to cure it.”

By managing cancer rather than trying to cure it, patients may run against the grain of accepted medical practice, says the report. Where an oncologist may want to proceed with aggressive chemotherapy or radiation therapy, the patient may have to insist on alternative treatments or less radical forms of traditional therapy.

This re-thinking of cancer as a chronic illness is fueled in part by advances in genetic research. Doctors understand that cancer is a disease caused by malfunctioning genes.

Drug makers are developing drugs to shut down those problem genes without harming healthy cells, as traditional chemotherapy does.

Traditional chemotherapy can’t be tolerated for extended stretches, says the report. “But a less-toxic pill that can be taken daily suddenly makes cancer look a lot more like chronic heart disease or diabetes than an acute terminal illness.”