By Pat Sherman
Some of the world’s foremost authorities on science, health and technology shared their ideas during the third annual The Atlantic Meets the Pacific conference, held Oct. 2-4 on the campus of UC San Diego and Scripps Institution of Oceanography.
During a panel discussion on innovative approaches to cancer treatment, Oct. 3 at Scripps Seaside Forum, Scott Lippman, director of the Moores Cancer Center at UC San Diego, compared the current revolution in oncology to the rapid transformation in Internet and computer technology of the early 1990s.
While cancers originating in the lungs, breasts or colon were once chiefly defined by their “site of origin,” today’s researchers are increasingly defining cancers by their “molecular signature,” Lippman noted.
“It’s changing completely the way we define cancer,” he said. “Genomics is just the beginning. This is a change in the way we do trials, and a change in the way we develop drugs to treat cancer.”
Drug trials that once dragged on for years and years are going by the wayside,” Lippman added.
“We can actually look into a tumor; we have the technology to identify what drives them, what makes them tick” and what their weaknesses are.
Kristina Vuori, president and interim chief executive officer of Sanford-Burnham Medical Research Institute in La Jolla, noted that while just a decade ago it was believed that breast cancer was a single disease, it is now known to be a mix of many different diseases.
“We are making really great scientific advances in the classification of diseases,” she said. “Thanks to technological advances, we can take biopsies of tumors and do very detailed micro-level analysis.”
Moving forward, Vuori said she hopes molecular diagnosis will be used to match a patient to the safest, most efficacious drug, based on their cancer’s molecular signature.
Sanford-Burnham researchers are also making advances in understanding the process of metastasis — the spread of cancer from the organ or area where it began, to another location in the body. In solid tumors, 90 percent of patient deaths are due to metastasis, Vuori said.
“What we now know is that in every cancer there is something that we call a ‘cancer stem cell’ that originally causes the tumor to happen,” she said. “It’s probably the culprit for why the cancer comes back after treatment. You can think of this cancer stem cell or tumor-initiating cells as a queen in a beehive. If you don’t destroy that queen, the beehive keeps coming back.”
Greg Sorenson, chief executive officer of Siemens Healthcare North America, said personalized medicine could help prevent cancer patients from being treated with drugs that don’t work for them.
“We as a system need to figure out ways to incentivize early and efficient diagnosis,” he said. “Everybody talks a lot about costs these days, but the most wasted healthcare dollar is the one that you didn’t even need to spend because you got the wrong diagnosis.”
Asked what aspect of cancer the panelists find most difficult to explain to patients and others not involved in the field of oncology, answers ranged from the fact that it’s difficult to know what causes most cancers — be it external, internal or genetic factors — to the time it takes to develop and get safe and effective cancer treatments on the market (as long as 7 to 10 years, on average).
Rather than discovering a panacea or “magic bullet” for cancer, Vuori and Lippman said it is a more realistic goal to make cancer a chronic, manageable disease.
“We will have some cures for some types, but my belief and my hope is that we can convert most cancers into chronic diseases, like heart disease or high blood pressure,” Lippman said.
The tech effect
During a panel on the ways technology is changing the patient experience, Peter Yu, president-elect of the American Society of Clinical Oncology, said technology should be employed to create a better record of patients’ experiences.
“Unfortunately, cancer is not curable in most cases … and so there are painful choices,” Yu said, noting that the term “quality of life” can be difficult to define.
“We have ways for patients to give us that information,” he said.
Pat Christen, president and CEO of HopeLab, talked about how her organization is helping adolescents with cancer deal with their disease via a series of online video games called, “Re-Mission 2.”
Christen said that when HopeLab developed the initial version of the game, they found “shockingly horrible” technology in many hospitals.
“You often hear about virtual divides … in the context of patients not having access to computers or the Internet or Smartphones,” she said, noting the need to get technology in people’s hands that is “meaningful to them, and in a context that makes sense.”
In the case of teen cancer patients stuck for long periods in waiting rooms, Christen said the game proved “very engaging for them, and emotionally salient,” helping them view their treatment as an adventure and fight to be engaged in.
“Data is incredibly important, incredibly powerful,” Christen said. “We need to be making evidence-based decisions, but people do not change behavior based on data. They change behavior when something is emotionally salient to them.”
In order to get people to change their eating habits, take medications or quit smoking, she said, the healthcare industry must pay closer attention to shifts in behavior that are constantly taking place — for instance, how memes and trends move through a culture, Christen said.
“Unfortunately, that’s often used for things that are not good for our health, but there is no reason they couldn’t be used for things that are pro-health,” she said. “Millions and millions of dollars get invested in making sure you’re buying the right car or the right perfume. If we had that same impetus we could make some pretty dramatic shifts” in people’s health habits, she said.
Jordan Shlain, founder and chair of HealthLoop, said health practitioners should be approaching the problem from a standpoint of “choice architecture,” which is used in marketing and product placement. “If you make something easy for somebody at the time they want to do it, they will do it,” he said.