The golden age

During his final State of the Union address last month, President Obama made curing cancer a priority for the federal government and placed Vice President Joe Biden “in charge of Mission Control” of what was described as a “moonshot” effort.

No one seemed more surprised than Biden, who’d recently lost son Beau to the disease, but he since has moved forward with a White House plan that includes a commitment of $1 billion to research accelerating development of new screenings and treatments.

This sort of news should excite physicians such as Dr. Sam Mazj, a hematologist/oncologist practicing at the Feather River Hospital Cancer Center in Paradise.

And it does—with a caveat.

“One billion dollars sounds like a lot, but in cancer research that’s not huge—a lot of the oncology community, they call it the slingshot, not really the moonshot,” Mazj said. During his two terms, however, the president has directed billions toward more research. “Eight years ago, there were a lot of cuts in cancer research.”

Knowledge about the disease has expanded widely this decade, resulting in breakthrough approaches that already have made their way into local hospitals. “I feel lucky to be an oncologist at this time,” Mazj told the CN&R in a phone interview from the cancer center in advance of his lecture on the state of cancer care on Feb. 25.

Dr. Martin Majer, a hematologist/oncologist at Oroville Hospital, is equally bullish—saying that cancer care “is getting better year by year, even month by month, actually.”

Both Mazj and Majer point to an immunotherapy involving checkpoint inhibitors, impacting how the body reacts to cancer cells, as a particularly revolutionary treatment with potential to grow beyond its current successful use. They note increased survival rates and longer lifespans. Moreover, they see widespread adoption of integrated, patient-centered treatment comprising interdisciplinary medicine, team decision-making that includes the patient and care plans that incorporate nutrition, exercise, psychology and more.

“The paradigm has shifted,” Mazj said. “The life-changing discoveries that are happening are amazing, but that’s not really what’s sealed the progress in oncology ….

“Over the last 40, 50 years, we’ve had every president say they were going to cure cancer [by] the end of the term. It never happened. Now we’re learning we have to be more realistic; sometimes the word ‘cure’ can’t be used, but we can [approach cancer] like a chronic disease like diabetes or high blood pressure.”

The new notion, he said, “is to make the cancer liveable”—find treatments that are the least invasive, with the least side effects, yet have the broadest impact. Equally important to understand is how the term cancer is an umbrella label.

“The idea of cancer as one disease, as we understood it, is wrong,” Mazj added. “There’s a lot of heterogeneity between the same cancer; breast cancer can be considered seven or eight different kinds of cancers. So a cure could be for some of them, not all of them.

“We are just at the beginning of understanding what cancer is. It took hundreds of billions of dollars to get where we are…. But I think the president is on the right path, at least.”

Two burgeoning realms in cancer research are immunotherapy and genetic sequencing. The fields are actually related, in that knowledge about DNA and RNA in cells can lead to advances in biomedicine.

Majer, chair of Oroville Hospital’s Cancer Care Committee, said in a phone interview that the checkpoint-inhibitor medications have proven to be a life-saving therapy.

Checkpoints are molecules on immune cells that trigger the fight against disease. Cancer cells sometimes can fool the checkpoints to avoid setting off this response. Checkpoint inhibitors target this interaction and have been used for melanoma (skin cancer) and certain lung tumors.

“Most promising about it is you basically treat the patient and then in the best of circumstances the immune system will do the job for you,” Majer said, “so you can actually bring people not only to remission but to long-term remission, i.e., a cure.”

He said at least 30 percent of these patients have “a pretty good long-term outcome.”

Meanwhile, Majer says, a federal project to map genetic changes—the Cancer Genome Atlas—is providing invaluable data that’s “helping to reclassify different types of malignancies into much tighter groups, which could be used therapeutically in the future.”

Oroville Hospital does its part for scientific research by assessing how local patients respond to their treatments. One such study focuses on breast cancer.

“When we started to collect the data five years ago, we didn’t even know how we could use it in the future,” Majer said, “but I guess you’ll find the piece of gold if you keep looking for the sediment in the river.”

Something less heady to come out of research, yet just as vital as biotech, is stressing the impact of lifestyle on cancer.

Adventist Health, the parent organization for Feather River Hospital, operates with lifestyle medicine as a guiding principle. Rebecca Vierra, a nurse navigator at Oroville Hospital, essentially acts as a case manager for cancer patients, and she’s long understood that diet and exercise play a role in prevention and recovery.

“We do offer a well-rounded approach,” she said, “not just the doctors and the meds but things that can help on the outside, too.”

Researchers have found that exercising 20 minutes daily reduces the risk of cancer by 50 percent, Mazj said. “That’s amazing—what chemotherapy do we have that works that way?” He says it’s time patients take charge of their health by asking proper questions of their doctors, avoiding carcinogens and exercising regularly. “But they need to see the numbers and know there’s a rationale and science behind it”—science from “the golden age of cancer care” that Mazj is excited to be part of.