Image: Dr Olivia Rossanese standing in front of the Centre for Cancer Drug Discovery
The strong public focus on a ‘cure for cancer’ is masking dramatic progress in extending the lives of patients with advanced cancer and turning it into a manageable disease long term, a YouGov poll of members of the public and cancer patients has found.
Just 28 per cent of people consider cancer a disease which can be controlled long term, compared with 46 per cent for heart disease and 77 per cent for diabetes – even though the average person with cancer now lives more than 10 years.
Just a quarter of people believe long-term survival rates from cancer are increasing ‘a lot’, and just 39 per cent feel that cancer could be ‘cured’ – meaning all symptoms removed without risk of relapse – in the next 50 years.
The Institute of Cancer Research, London, believes that focusing exclusively on curing cancer risks overlooking the huge progress that has been made in allowing people with advanced disease to live much longer with a high quality of life.
The reality for many people with advanced cancer is that cures are not yet possible but we are doing much better at offering new personalised treatments that can greatly extend lives.
The Institute of Cancer Research (ICR) argues that while curing cancer will always be the ultimate goal for patients and researchers, new ‘Darwinian’ approaches to treatment now offer the hope of controlling even advanced disease in the long term.
The ICR commissioned polls of 2,103 members of the public and 355 people who have been treated for cancer to inform the development of its new Centre for Cancer Drug Discovery by assessing public understanding of the major challenge of cancer evolution and drug resistance.
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'Overly binary approach to cancer could be unhelpful'
The ICR – a charity and research institute – is launching the world’s first ‘Darwinian’ drug discovery programme within the new centre aimed at achieving further dramatic improvements in the proportion of patients whose disease can be controlled long term and effectively cured.
Statistics show that the average length of survival from cancer has approximately doubled over a decade as new targeted drugs, combination treatments and immunotherapies begin to greatly improve long-term control, with a good quality of life, in patients with advanced disease.
Cancer’s ability to constantly adapt, evolve and develop drug resistance is the cause of the vast majority of cancer deaths yet the polling found that only half of people identified cancer evolution and drug resistance as one of the biggest challenges in cancer research and treatment.
Worryingly, the widely used term ‘all clear’ is commonly misunderstood by both the public and patients, with a third of both groups believing it means the disease is completely cured, rather than simply undetectable and with the potential to still return.
Only 60 per cent of people in the YouGov poll understood that the term ‘drug resistance’ in cancer means the cancer treatment has stopped working – with many assuming the term related to antibiotic treatment. Some 15 per cent of the public, and 16 per cent of cancer patients, were not aware that cancer can resist treatment and come back – a tragic reality for many people with cancer.
Scientists at the ICR argue that an overly binary, ‘cure or nothing’ approach to cancer could be unhelpful, not only in overshadowing the progress made so far, but to our understanding of how best to tackle the disease in future.
'It doesn’t stop me living my life'
The ICR shares the goal of patients in wanting cancer to be completely cured but also believes that it is vital to take people on a journey so that they understand and accept new evolutionary approaches to treatment that can control even advanced cancers in the long term.
Chrissie Mortimer, from Devon, was 61 years old when she was diagnosed with the blood cancer chronic myeloid leukaemia – that was 10 years ago. Chrissie has been living well with her cancer thanks to imatinib, one of the first targeted cancer treatments to become available.
Chrissie, who is now 71 and, thanks to her treatment, has been able to continue working and volunteering with refugees, described living with cancer:
“Getting told I had cancer was really scary. It all happened so quickly, and I didn’t really have the time to process what was happening to me and what the diagnosis would mean for my future. I was put on a targeted drug pretty much straightaway, and I’m still on the same treatment now.
“I never would have thought of cancer as something that can be managed, but it’s been 10 years since I was diagnosed, and I’d say I’m managing pretty well! I still work one day a week, and I now spend a lot of my time supporting a local refugee family – as well as doing lots of yoga.
“I am aware that I’m living with cancer, but it doesn’t stop me living my life. There’s still so much I want to do, and I hope that new treatments keep being discovered and developed.”
Ambitious Darwinian drug programme
Barbara Ritchie Lines, from Birmingham, was diagnosed with breast cancer in 2005 and, following eight years of treatment, she is no longer undergoing active treatment and her cancer is now undetectable. Barbara’s successful treatment has meant she has been able to enjoy quality time with her grandchildren.
Barbara explained what a difference advances in cancer research and treatment have meant to her life:
“When I first got diagnosed, I was told that I had maybe only 12 months – but it’s been 14 years, and here I am. I’m so grateful that I now have all this time to spend with my new grandchildren. Being here to hold my seven-week-old grandson means the absolute world to me.
“It is always at the back of your mind that the cancer might come back. I try to keep it there so I can carry on living my life, but I hope we continue to see new drugs and treatments to make sure that, no matter what happens with our cancer, the doctors will be ready and able to overcome the disease. Cancer doesn’t have to be the end – it can be the start of a whole new life.”
The ICR is raising the final £14 million it needs to finish the Centre for Cancer Drug Discovery and equip it with the state-of-the-art facilities needed for its ambitious Darwinian drug programme.
Scientists who will be working in the new centre believe its pioneering approach can deliver long-term control and effective cures for cancer that are comparable to the progress made in HIV – a disease which, according to the YouGov poll, over 60 per cent of the public felt could be controlled long term.
The Holy Grail of researchers and patients
Dr Olivia Rossanese, who will be Head of Biology in the new Centre for Cancer Drug Discovery, said:
“Curing cancer will always be the Holy Grail of researchers and patients, but focusing exclusively on this risks masking the dramatic progress we are making against the disease, where even patients with advanced cancer are increasingly experiencing disease control in the long term with a good quality of life.
“By focusing overwhelmingly on cure, treatment has tended to be as aggressive as possible but in some patients there is a risk that that could drive cancer evolution, and the return of the disease in a more dangerous and less treatable form.
“We believe cancer should no longer be a case of ‘cure or nothing’. We know there’s a growing population of people who are living longer and better with cancer and that is something to celebrate.
“At the ICR, our aim is to discover many more anti-evolution treatments to overcome drug resistance, so we can not only cure a greater proportion of patients but also give others with advanced disease the chance of a much longer and better life.”
Making great progress against cancer
Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, said:
“Overcoming the challenge of cancer evolution and drug resistance is the key to defeating cancer. Through our new Centre for Cancer Drug Discovery, we are aiming to find new ‘anti-evolution’ approaches to treatment that allow us to control even advanced cancers long term, as well as giving a growing proportion of patients the opportunity of a cure.
“We believe it’s vital that we can take the public on this journey with us, by understanding that cancer is a hugely complex and evolving disease, and that we need to move beyond the old, binary ‘cure or nothing’ thinking to find innovative new ways of treating the disease that can give people a longer and better life.
“The good news is that thanks to research, we are already making great progress against cancer, with diseases that just a few years ago were lethal now increasingly manageable for patients long term. If we can finish off cancer evolution, we will effectively finish cancer.”