The 40-Year War

Ed Rabinowitz
Published: Tuesday, Mar 08, 2011
It was 40 years ago in January that Richard Nixon, still grappling with the Vietnam War and not yet overwhelmed by scandal, stood before Congress to deliver the State of the Union address and declared a bold new goal for the nation.

The federal government would launch an “intensive campaign to find a cure for cancer,” devoting as much attention to the disease as it had to splitting the atom and reaching the moon, Nixon said.

Although he did not say the words, Nixon became the man who declared “war on cancer.”  By year’s end, he had signed the National Cancer Act of 1971, making “the conquest of cancer a national crusade.”  The act set aside $100 million to create cancer centers and fund new research.

Today, the National Cancer Institute (NCI) spends more than $5 billion a year. Opinions abound about how the war on cancer has been waged and what has been “won.”  While cancer is no longer the death sentence it was in the 1970s, the American Cancer Society predicts that more than 1.5 million people in the United States will be newly diagnosed with the disease this year.

“It is not unreasonable to state that we are actually at the beginning of the war on cancer,’ since we now have for the first time a genuine understanding of the fundamental molecular pathways that are the main drivers in the progression of malignant disease,” said Maurie Markman, MD, vice president of Patient Oncology Services and national director for Medical Oncology at the Cancer Treatment Centers of America, Philadelphia, Pennsylvania, and editor-in-chief of Oncology Net Guide.

“Unfortunately, we are also now very aware of the true complexity of cancer, and the fact it is highly unlikely a ‘magic bullet’ will be discovered that will cure all, or most malignant conditions,” he said.  “Further, evidence suggests that a more successful strategy will be to consider many advanced malignant diseases to be serious chronic illnesses, where ‘cure’ is an unrealistic goal but where extended control, possibly measured in ‘years,’ is a legitimate possibility.”

As in any war, the perspective of those on the battlefield often depends on their vantage point. Oncology Net Guide asked researchers and clinicians to mark some of the milestones in technology and biomedical research that have occurred during the war on cancer and discuss how these changes have affected their practices.

Robotic Tools Revolutionize Prostate Care

Ihor Sawczuk, MD, is co-chair of Urologic Oncology at the John Theurer Cancer Center, Hackensack, New Jersey. He measures the manner in which technology has revolutionized care by changes in the way oncologists recognize and treat prostate cancer. Physicians have long known the anatomy of the prostate; the da Vinci Robotic Surgery System, with 10 times magnification and high-definition imaging, offers new and expanded views.

“Those areas that we knew about, now we saw them in a way that was never possible,” Sawczuk said. “And when you looked at it you said, ‘Okay, let me rethink those areas and how I can improve on what I’ve been doing surgically. Improve my techniques. Make them finer.’ Doing so improves the quality of life for the patient, and the outcomes.”

The benefits of robotic technology are numerous, Sawczuk said. There is very little blood loss, so transfusion rates have decreased significantly.  “We probably transfuse one to two percent of patients who undergo radical prostectomy with the robotic technique, compared with a 30 to 40 percent transfusion rate with open procedures.” In addition, pain control is better due to the smaller incisions, and patients’ return to normal work functions is more rapid due to the laparoscopic technique. With quality-of- life issues such as incontinence, the return to normal control of urination appears to be a faster process, according to Sawczuk.

The growth and acceptance of the da Vinci system has been rapid as well. In 2005, the national usage rate was approximately 20 percent. Today, it ranges from 70 to 75 percent. The rate of utilization throughout the John Theurer Cancer Center is about 98 percent, said Sawczuk, who first adopted robotics in 2004.

“I found that the equipment allowed me to utilize my normal hand functions; I just had to learn a new piece of technology,” he said. “And that was the beauty of the da Vinci robot. It allowed six-degree freedoms of hand rotations. It didn’t limit you to straight laparoscopy, which is like operating with chopsticks. There was natural progression to enter that machine.”

What’s next? Sawczuk said he envisions operating rooms using virtual technology, where doctors may not have to actually sit at a machine. Instead, the machine will be all around them. “Like in the movies,” he said. “You’ll be standing there, moving your head, moving your hands, and things will respond to you. I can certainly see that in my lifetime.”

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