Are We Treating Cancer Wrong?

Azra Raza, an oncologist at Columbia University, has recently published her second book, “The First Cell: And the Human Costs of Pursuing Cancer to the Last.” Having lost her husband and many of her patients to cancer, she incorporates her firsthand experience into her book, describing "how hard it is to reconcile compassion with science and hope with realism." She examines the way oncologists in the U.S. currently treat cancer and simultaneously looks ahead, discussing what she thinks future treatment may come to be and how we should strive to arrive there.

Raza describes how ineffective current cancer treatments are, citing the statistical ineffectiveness of chemotherapy against metastatic cancers despite its hefty price, which averages around $100,000 per year of treatment. It gives false hope to desperate and suffering families, who are sometimes even willing to dip into life savings for the aforementioned treatments which may, at best, grant only a few more years of life. Raza quotes research done in the U.S., mentioning that “42.4 percent of the 9.5 million cancer cases had lost all of their life savings within two-plus years.” She poses the question as to whether a couple of more months or years on the ventilator are worth a family’s life savings. The patient’s opinion should be considered too. Keeping them on the ventilator may make them feel like a burden—a burden that’s dragging the family down but could easily be lifted. Associating the emotional loss of a loved one with the loss of physical value may only make it harder to move on. This also substantiates the possibility that public sentiment may tend toward an ill perception of doctors, as radicals who believe that current medicine is not worth such immense amounts of money are sure to voice their opinions.

Additionally, Raza mentions that the many stories of those who die are overlooked, whereas the story of the occasional miraculous survivor is almost always far-reaching. These stories mislead the general public into believing the fantastical notion that medical science, in its current state, can really cure anyone and anything. Raza also calls out modern molecular biologists as being arrogant and self-assured of their own abilities. Her explicitness is her way of encouraging people to explore other possible treatments or more effective paths.

To comprehensively improve cancer treatment, Raza suggests allocating more funds into researching the first cancer cell and early changes before a tumor develops. This underemphasis on late-stage and metastatic cancer research implies Raza's strong position on giving up on "incurable cancers"—the idea that doctors should take patients off of their ventilators at that point of incurability. This new way of looking at how we treat cancer requires a huge leap to be socially accepted in a country like the U.S., which generally has an "optimistic culture and a commercially driven health care system." Doctors, including Raza, often develop an emotional connection with their patients, trying to give them hope for life while explaining the realities of their conditions. They operate again and again under the protection of the law and at the request of ignorant, bereaved families. This, however, only postpones the inevitable day that the doctors spell out the truth to them: that the patient’s cancer is incurable. This ultimately leads to what Raza believes is the main problem with the U.S.’s way of treating cancer: "grotesque overtreatment of very sick people."

Though Raza’s concern over the treatment of late-stage cancer patients is very much a real problem, she does gloss over new lines of research being published today. For example, extensive research on cancer immunotherapy is extremely promising, with many new signals, proteins, and viruses with positive medical implications being found on a regular basis. Just last month, a study was published in the peer-reviewed journal “Immunity,” which described the discovery of a virus engineered to kill tumor cells and support immune cells. Clearly, there is no one straightforward path researchers should go down to find the sure-fire way to combat or even approach cancer. Cancer researchers hoping to one day cure all cancers have an arduous journey ahead of them, requiring the collaboration of both brilliance and open-mindedness, but Raza’s “The First Cell” shines a disturbing light on the culture of cancer treatment in a commercialized and mass-produced society.