The mandate of the National Cancer Act of 1971 was “to support research and the application of the results of research, to reduce the incidence, morbidity, and mortality from cancer,” and we have done that.
1.In your new book, The Death of Cancer (co-authored with your daughter Elizabeth), you describe the early days of your career, and particularly how medical oncologists, surgeons, and radiologists were often at odds about the best way to treat cancer patients. Do you think that problem still exists to some extent, or are all disciplines working together now to provide comprehensive cancer care?
Dr. DeVita: Things have improved greatly, especially at major cancer centers where the essence of good care is provided by teams of physicians. But it’s not universal. I have recently seen some examples of marginal care for complex patients because the patient was seen by one physician at a time, a sequence resulting in lack of communication and, worse, unnecessary delays in starting treatment. And this was at a major university cancer center-they apparently have not gotten the message! It is good for patients to ask about whether a team of physicians will be involved. In private practice, assembling teams is more difficult so we still have work to do there.
2.Likewise, do you think oncologists are currently too constrained by treatment guidelines and standards of care, which may prevent them from trying new therapies or being more creative when it comes to treating their patients?
Dr. DeVita: Yes, I do. Guidelines are backward-looking in a rapidly changing field like cancer. But what worries me more are the constraints on innovation. New approaches to treatment in this era of targeted therapy need maximum flexibility to mix and match treatments in order to control the wily cancer cell.
3.What do you think needs to happen in order for the US Food and Drug Administration (FDA) to speed up the approval of new agents, which you indicate in your book is one of the biggest obstacles to patients receiving the treatment they need in the time they need it?
Dr. DeVita: The FDA is approving drugs based on outdated methods. It should approve new cancer drugs based on their safety profile and their ability to hit important molecular targets. And I think cancer centers have matured enough to handle all the early trials by themselves. So, both the National Cancer Institute (NCI) and FDA should delegate responsibility for all phase I and II trials to NCI-approved cancer centers. This would not only increase the speed of developing new drugs tenfold, but it would cost less.
4. When writing this book, what did you hope oncologists (both experienced and new to the field) and patients alike would take away from it?
Dr. DeVita: The mandate of the National Cancer Act of 1971 was “to support research and the application of the results of research, to reduce the incidence, morbidity, and mortality from cancer,” and we have done that. I would like people to know the war on cancer was a success and that the best is yet to come with the emergence of targeted therapy and immunotherapy. It’s a very exciting time to be entering the field of cancer research.
For patients, they need to know that for newly diagnosed cancer there is something that can be done for everybody. If a doctor tells you otherwise, find another doctor.
Financial Disclosure: The author has no significant financial interest in or other relationship with the manufacturer of any product or provider of any service mentioned in this article.