The Death of Cancer

Sandeep Jauhar in The New York Times:

BookWhen I was doing my medical training nearly 20 years ago, there were two kinds of residents: those who were planning on specializing in oncology and those who couldn’t tolerate the subject for even a month. One night when I was on call, I worked with someone in the second camp. He told me about a patient of his, an elderly woman with pancreatic cancer that had grown into her bile duct and metastasized through her intestinal tract. She had been through several rounds of ­chemotherapy without success and was ready to quit treatment, but was afraid to tell her oncologist. “She told me, ‘I don’t want him to think I’m giving up,’ ” my colleague said, obviously disgusted that she didn’t feel comfortable speaking freely about her goals. He encouraged her to choose hospice care. Two weeks later, he said to me, his patient’s hospice aide came up to him on the ward. “She told me that my patient made her promise that the day she died, she would come find me and tell me. She said my patient wanted to thank me for encouraging her to die the way she wanted to.” I thought of this story at various points while reading “The Death of Cancer,” Vincent DeVita Jr.’s fascinating if hubristically titled new book, co-authored with his daughter, Elizabeth DeVita-Raeburn, a science writer. Today, more than four ­decades after President Nixon declared war on cancer and with so many new weapons in our arsenal supported by big budgets and a decidedly aggressive posture, when is it O.K. to give up? When is it best to ­surrender? DeVita himself has been one of the top commanders in this war. He was in the vanguard of chemotherapists, engineering the first cure for Hodgkin’s disease and diffuse large B-cell lymphoma. Later, he was director of the National Cancer Institute, physician in chief at Memorial Sloan Kettering Cancer Center in Manhattan and president of the American Cancer Society. In DeVita’s telling, we are winning this war. Childhood leukemias are now almost completely curable. Death rates for almost all types of cancers are steadily decreasing. We have an array of new biological molecules and immunotherapies that put the old slash-and-burn cancer drugs to shame. When he says, “We have the tools to eradicate cancer,” he is someone we should listen to.

Sadly, however, his assertion flies in the face of certain facts. As DeVita himself notes, cancer cells frequently mutate, becoming smarter at neutralizing even the most aggressive chemotherapeutic cocktails. Cancer remains the second-biggest killer in the United States (after heart disease). It seems highly unlikely that a disease that has been documented for ­mil­lenniums, that is written into the very nature of our cells, will ever be eliminated.

More here.