Chances are you know someone who has been impacted by cancer. That’s because upwards of 2 million people are diagnosed with the disease every year in the United States. Cancer affects us all, regardless of age, race, or sex.
Cancer treatment over the past several decades have significantly improved, and cases that once were thought to be incurable now have more positive outcomes and survival rates.
“I have seen the treatment of lung cancer go from a metastatic and incurable disease, to an era where we have immunotherapies and targeted therapies and patients who are living for years on these drugs with wonderful quality of life. As we personalize our therapies, we match the right drugs to the right patients at the right time,” said Roy S. Herbst, MD, PhD, Ensign Professor of Medicine (Medical Oncology) and Professor of Pharmacology. Herbst is chief of the Section of Medical Oncology in the Department of Internal Medicine, and he specializes in lung cancer.
“Clinical trials performed here at Yale have resulted in improved survival to the point where patients are living disease-free 10 years later. But, we need to do even more. We need more therapies for the benefit of more patients and drug combinations to treat those patients who have primary resistance or who develop resistance later.”
Prevention and early intervention are vital when it comes to cancer care.
“Cancer prevention will help more people than any treatment ever can,” Herbst said. “We prevent cancer with what we call primary prevention, such as avoiding toxins like smoking, radon gas, asbestos. And, we have vaccines that may prevent some cancers, such as those associated with exposure to human papilloma virus (HPV)."
There’s the disease in those who have access, and the disease in those who find barriers. The patients who have insurance are more likely to have good baseline health and the wherewithal to navigate the health care system, but the others may not have health literacy, may not have support, may not have health insurance, and may not have good health when diagnosed. It really changes everything.
Andrea Silber, MD
As people age, their risk of cancer increases, which makes cancer screening all the more important. “We should screen patients for colon cancer starting at age 45 and up; lung cancer for those who have smoked more than 30 pack-years of cigarettes in the age range of 55 to 75; as well as for breast cancer and prostate cancer,” Herbst said.
While preventative care can be life-saving, people in underserved neighborhoods often are at a disadvantage. Andrea Silber, MD, professor of clinical medicine (Medical Oncology), associate clinical director at the Center for Community Engagement and Health Equity at the Yale Cancer Center, says she is always looking for ways “to level the playing field and to make sure that everyone has equal access to care so that they can have equal outcomes.”
While all races and ethnicities are susceptible to cancer, certain communities suffer worse outcomes. Because of this Silber says cancer can be thought of as two separate diseases. “There’s the disease in those who have access, and the disease in those who find barriers,” Silber said. The patients who have insurance are more likely to have good baseline health and the wherewithal to navigate the health care system, she said. “But the others may not have health literacy, may not have support, may not have health insurance, and may not have good health when diagnosed. It really changes everything.”
“There are disparities in both inclusion and outcome of clinical trials since they are not equally available to all groups. If you look at minority accrual to clinical trials, it is often less than 5 or 10 percent,” added Herbst.
When considering gender and racial disparities in health outcomes, Silber said we must pay attention to the fact that many working people do not have health insurance. “So many jobs are incredibly important, but they’re not well-compensated, nor do they provide insurance. As a nation, we have to work harder to make sure there really is equal care.” Silber often hears patients say, “I have to be well; I don’t have time to be sick,” when they come in for treatment.
What does all this mean for the future of cancer treatment? Although there are more and better treatment therapies than in years past, much still needs to be done to educate people about the importance of cancer screening, early intervention in cancer care, and the value of participation in clinical trials, as well as greater access to care for underserved and overburdened populations.