Tag Archives: cancer

Lessons From DeVita’s “Death of Cancer”

What practical advice can a common-sense senior glean from Vincent Devita’s book, The Death of Cancer? DeVita doesn’t shy away from the practical side of things — in fact, he devotes his final chapter, Outrageous Fortune, Part II (Part I was about a friend) to describing how he dealt with his own prostate cancer diagnosis.

One lesson from that chapter is that the person receiving the diagnosis is not in a good position to be making decisions alone. Someone newly diagnosed is going to be anxious and worried, and won’t be hearing everything the physicians have to say. DeVita himself, a world renowned cancer treatment expert, found he wasn’t thinking clearly and had to turn to a friend, another world renowned cancer expert, for guidance in his decision-making.

The problem is that most of us don’t happen to count cancer experts among our friends. So let’s hope that when the time comes, we have a doctor we trust as well as friends and family who can support us emotionally and even help us with our research.

Research is going to be necessary. DeVita has a rather disturbing few pages on the best places to go for the treatment of various types of cancer — and it’s information that the lay-person would be challenged to discover. Fortunately, DeVita assures the reader, “the United States has the best cancer care in the world. Not all patients receive their care at cancer centers, nor do they need to. Much of cancer care can be delivered at community hospitals.”

But someone diagnosed with an unusual cancer, an advanced cancer, or a type with a poor survival rate, should be at a center, DeVita writes, that is “cutting edge” and practicing “state of the art” cancer treatment and management.

How do we find such places? DeVita has his recommendations, writing that the National Cancer Center in Bethesda, the Dana-Farber Cancer Center in Boston, and the Stanford Cancer Institute are the best places to go for treatment of lymphomas. DeVita goes on — “Yale may be the best place to go for cutaneous T cell lymphomas but not for any other type.” “The Mayo Clinic is good for state of the art care for common tumors, but I wouldn’t send someone there who needed something creative or inventive.” “The best place for adult leukemia therapy is MD Anderson in Houston, Texas.”  You can read other such recommendations on pages 238-239 of DeVita’s book, but it’s time-sensitive advice. As time passes, some centers will improve and others may decline.

Anyway, how is a lay person to find out which is the best center for his or her particular situation? That’s where the research comes in. It’s going to require asking a lot of questions, doing a lot of internet research, and perhaps, as dear friends recently did, traveling to potential treatment sites to form your own opinion.

DeVita favors centers that devote themselves exclusively to treating cancer patients to university-based centers with a variety of other priorities. He advocates aggressive treatment over treatments that may leave the patient more comfortable, but have, in his view, little chance of success. And he wants patients to have access to the latest and best approaches, such as combination targeted chemotherapy and immunotherapy. There might be a new treatment available now, he argues, that will enable a patient to survive for several years, when something even better may have come along to give still more years of life.

DeVita’s book has certainly convinced me that advanced, aggressive treatment at the best possible facility would be worth a try. Whether I would still feel that way should I live into my eighties is a question, though I would probably still give a first round of treatment a shot. Maybe by then, cancer will have been well and truly conquered, though I doubt it.

 

 

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Noted Physician Predicts End of Cancer As Major Health Issue

DeathofCancerWe seniors all have our little ways of whistling past the graveyard. Some avoid making a will. Some avoid completing an advance directive. For years, I’ve avoided reading about cancer. This is not acceptable in a common-sense senior, so when I saw that Dr. Vincent DeVita’s book, The Death of Cancer, was getting good reviews, I decided to mend my ways.

Perhaps it’s just as well that I waited, since the book is an education in the tremendous progress that has been made against cancer over the past few decades — so much progress that DeVita predicts “the end of cancer as a major public health issue.” No one could be better qualified to make such a judgement. DeVita has been a clinician and cancer researcher since the 1960s, director of the National Cancer Institute, physician in chief at Memorial Sloan Kettering Cancer Center, director of Yale University’s Cancer Center, and president of the American Cancer Society.

Thanks to advances in chemotherapy, the use of combined therapies, immunotherapy, and other progress, childhood leukemia, Hodgkins disease, and several other types of advanced lymphoma are now almost completely curable. Mortality from colon cancer and breast cancer has dropped sharply, and major advances have been made against ovarian cancer, advanced melanoma, prostate cancer, and even lung cancer.

Mary Lasker, presenting an award in 1957

Mary Lasker, presenting an award in 1957

This progress has been achieved largely through government programs and government spending — something those who want to slash the federal budget should think about. Government efforts got a big boost in 1971, when President Nixon, with bipartisan support in Congress, launched the War on Cancer. DeVita is fascinating on the role of Mary Lasker, philanthropist, socialite, and skillful manipulator of vain politicians, in making the War on Cancer possible through passage of the National Cancer Act.

Of course, the War on Cancer hasn’t been a happy story of a straight-line advance to victory. The original goal of conquering cancer by 1976, the bicentennial year, was adopted by Lasker as a lobbying tool, but was never realistic. That original goal has sparked numerous damaging stories over the years about the failure of the War on Cancer — a claim that DeVita is at pains to debunk.

His tale, however, is full of descriptions of epic clashes between institutions, departments within institutions, and famous physicians that make the reader grateful we’ve gotten as far as we have. Renowned cancer centers have resisted adopting new and better approaches or modified treatment protocols for unscientific reasons, rendering them ineffective. Surgeons have persisted in performing disfiguring radical mastectomies to treat breast cancer, despite evidence that lumpectomy followed by chemotherapy is more effective in preventing recurrence. DeVita even suggests that some physicians have continued using outdated treatments of various sorts, and denounced those advocating new approaches, simply because their incomes depended on it.  He is particularly biting in criticizing the Food and Drug Administration for delays in approving new drugs for use in cancer patients who have no other option than death.

The Death of Cancer is a gripping, highly informative book that is well worth reading. But what does it mean for a common-sense senior who faces a cancer diagnosis? Or who faces such a diagnosis in a loved one? Where do we turn? How do we find the best treatment? Common Sense for Seniors will look at these issues in an upcoming post.