It's a transformative time in medicine, and few things better illustrate this fact than the inspiring talk I heard recently from Dr. Geoffrey R. Oxnard, an oncologist who also happens to be an assistant professor at the Harvard School of Medicine.
Oncology, or the branch of medicine that deals with tumours and cancer, is leading the profession's charge toward precision medicine -- a new approach that places the focus on the individual patient and all the ways that patient is unique.
For example, Oxnard's research identifies different lung cancer mutations, then attempts to create a therapy designed to attack only that particular form of mutated tumour.
That's a lot different from the traditional way to fight cancer, which usually involved some form of chemotherapy. The old way saw the patient swallowing a cocktail of drugs, which would then poison fast-replicating human cells, such as tumour cells. The problem was, the chemotherapy also affected other fast-replicating cells, such as those in the gut, hair and bone marrow. It was a bit like going deer hunting with an atom bomb -- the docs got the tumour, sure, but also caused a lot of collateral damage. Like the patient's hair fell out. Consequently, quality of life during chemotherapy was terrible.
Precision medicine aims to treat cancer without the nasty side effects. The process starts with an oncologist taking a sample of the tumour tissue and analyzing all the different ways the tissue is special or unique -- with DNA tests and other lab analysis that examine the tumour's cellular makeup.
The cancer doc then uses that information to determine exactly the right therapy to kill just that specific type of tumour -- minimal side effects, maximal cancer damage. Some of the new precision drugs involve targeted therapies, which can be aimed at certain proteins on a tumour. Another category of precision approach is the immune therapy, which involves activating the body's disease-fighting mechanisms -- white blood cells and stem cells -- to fight off exactly the type of cancer affecting the patient.
The approach has triggered a wave of new studies that are inundating medical journals with more-effective-than-ever approaches. For example, the New England Journal of Medicine recently published research from some of Dr. Oxnard's colleagues at Boston's Dana-Farber Cancer Institute that featured a 61 per cent response rate for one of the toughest types of tumours out there.
Oncology's "precision medicine" approach also is creating a halo effect that's changing how other clinicians practice medicine. The doctor of the future will need to become an expert in a whole host of new diagnostic techniques, from genomics to molecular medicine. And if the promise of precision medicine pays off, docs will become a lot better at the sort of preventive medicine that keeps people healthy, longer.
No matter how precise and high-tech medicine gets, low-tech lifestyle will always play a part in how healthy we are. For example, Dr. Oxnard provides his patients with three counterintuitive principles that he says will help them survive lung cancer -- as well as many other maladies. Here they are:
1. Don't act sick
Sure, Dr. Oxnard says, all you feel like doing is lying on a bed, maybe watching TV. But resist that. Get outside, run errands, try to be active. Acting like you're sick increases your tendency to be sick.
2. Don't lose weight
Our world is obsessed with being thin, but when it comes to cancer, an extra 10 pounds can mean the difference between life and death, particularly when dealing with complications like pneumonia. So Dr. Oxnard suggests his patients "liberalize" their diets to put on some weight.
3. Don't be a tough guy
This one, he says, is the most important. Stoicism -- the drive to grit one's teeth and endure symptoms without complaining -- can be harmful for patients, who should partner with their doctors to identify and treat their symptoms as they happen. So stay in touch with your body. Complaining can lead to better care.
I came away from the talk inspired by Dr. Oxnard's hopeful attitude. Precision medicine is going to require some transformation in medicine, requiring the doctor of the future to become both scientist and clinician to fully treat the human condition. Yes, it's a transformative time for cancer care and medicine and the future will only get better.
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