"Let us honour if we can
The vertical man
Though we value none
But the horizonatal one."
Over the last few months, I've been having some interesting conversations with various people involved with cancer research and have been impressed with how many are going about looking at the clinical trial conundrum with a new and fresher lens. Sometimes doing the same thing repeatedly isn't always in the best interests of everyone, the researchers, doctors, patients, manufacturers, regulatory authorities.
The good news is that there are some new initiatives being discussed that break the mould from just looking at either first-line metastatic or relapsed, refractory disease as the first port of call in a isolationist nihilistic approach. This is good news and I'm hoping that more people taking on a broader, more holistic perspective will change the kaleidoscope of collective thinking.
Think about it.
What happens when patients stop adhering to therapy? How does that affect outcomes? What education is needed to help address this? Who should provide the education? Giving out pills boxes and chips in lids isn't going to change much without a link to why it matters.
At the recent EHA meeting, Jan Geissler gave an excellent overview of the broader factors affecting patients in two different sessions from the patient perspective. I hope it opened many physicians eyes to some of the underlying issues. This issue is nowhere near as simple as many may think. In a different session, David Mahon gave a fascinating talk on the impact of patient adherence on outcomes in CML based on some serious research. As one might expect, they were affected negatively, but the shocking piece of information was how many physicians encouraged dose holidays or skipping a dose, saying it wouldn't matter. This creates the wrong impression to start with.
More recently, the news that compliance with chronic tamoxifen therapy for treatment of hormone sensitive breast cancer is often poor, is not a surprise given the tolerability issues associated with the drug, but what is surprising is how little take-up this made in the medical news (HT Jody Schoger). How many women had a poorer outcome from their hormone treatment as a result of less than 90% compliance? What can be done about it? Very little comment or analysis in the medical press or advocacy world ensued.
In the end, we need more creative leaders working on this problem, a greater synergy between translational and biology research with clinical practice, cross functional working groups that involve multiple stakeholders, including patient advocacy, working towards a common goal for the greater good.
It is only when all of these factors come together in multi-functional teams that faster and better progress in cancer outcomes, in terms of both survival and quality of life, will ultimately be made. Where's that Cowbell when you need it?
What are you doing to help change things?