Before we launch a new cancer ‘moonshot,’ let’s talk about cancer care right now.

Whatever your political leanings, you have to appreciate President Biden’s deep personal and tragic connection to the No. 2 killer of Americans, cancer.  The disease killed his oldest adult son in the prime of his life, right before Biden’s eyes. So the President’s new call for a “moonshot” to cut in half the death toll of cancer over the next two decades is beyond admirable.

But, as the President himself might say, “Here’s the deal.” There are significant issues that are making the long war on cancer a grueling campaign. Savvy patients need to know about five key problems. The goal is simple: Let’s stay happy and healthy in ’22 and beyond!

Progress is occurring in the battle against cancer. As CNN recently reported, based on an annual research report from the American Cancer Society:

“The overall cancer death rate dropped by about a third (32%) from its peak in 1991 to 2019, from about 215 deaths for every 100,000 people to about 146, averting about 3.5 million deaths during that time … The [society] projects that there will be about 1.9 million new cancer diagnoses and more than 609,000 cancer deaths in the United States in 2022, including about 350 deaths per day from lung cancer, the leading cause of cancer death.”

The society also reported this:

“Cancer survival is typically described in terms of relative survival, which is a measure of life expectancy among cancer patients compared to that among the general population of the same age, race, and sex. The 5-year relative survival rate for all cancers combined has increased substantially since the early 1960s, from 39% to 68% among white people and from 27% to 63% among black people. Improvements in survival reflect advances in treatment, as well as earlier diagnosis for some cancers. Survival varies greatly by cancer type and stage, as well as age at diagnosis.”

So why are we already doing a lot better than a few decades ago? Is it cancer screening?  Yes, and no.

Advocates heavily promote cancer screenings — and for some types of cancer, there are big benefits. Here’s the big but: patients need to be wary of excess exuberance about testing. As the New York Times reported of Biden’s call, for example, for increased cancer screening:

“More screenings are not the answer — the only cancers for which screening has indisputably lowered the death rate are colon and cervical. Death rates for other cancers, like breast, have fallen, but a large part of the drop, if not all of it, is because of improved treatment, said Donald A. Berry, a biostatistician at the University of Texas M.D. Anderson Cancer Center who has spent decades studying these issues. ‘Everybody loves early detection, but it comes with harms,’ he said — principally, the harm of finding and treating tumors that do not need to be treated because they are innocuous. ‘The harms we know, but the benefits of screening are very uncertain,’ he said.”

Patients should consult carefully with their own doctors about cancer tests, especially those postponed due to the coronavirus pandemic. Expert recommendations have shifted recently on screenings for colorectal and lung cancers: A blue-ribbon U.S. panel advising earlier tests for the former (starting at age 45, instead of 50) and, for the latter, a more emphatic advisory for screenings for smokers and those who have quit.

Just a reminder that in more normal, pre-pandemic times, up to a third of medical spending went for over-testing, over-diagnosis, and over-treatment. Tests can be invasive, painful, and unnecessary procedures, with an estimated $200 billion in the U.S. expended on medical services that little benefited patients. 

As medical science makes advances in cancer diagnosis and treatment, patients increasingly must grapple with agonizing choices. They’re complex, and there are no certainties. And frankly, there are some ripoffs ready to take advantage of desperate people.

The psychological burdens — and harms — of the disease can be profound, especially for patients with aggressive or advanced cancers. Big Pharma, drug industry regulators, and the news media don’t make the situation easier, as they can dangle unreal hopes about novel therapies that may be impossible for patients to access and may not offer the hyped outcomes.

Many people hear news reports about promising cancer drugs. Researchers say that makers and regulators, indeed, have allowed rising numbers of such prescription medications to pour on to the market, many on an expedited basis. But critics say too many of these meds win federal Food and Drug Administration approval not based on whether they improve the quality or duration of patients’ lives. Instead, doctors may be permitted to prescribe them because of the drugs’ effect on “surrogate endpoints.” This means they may shrink tumors for a time or reduce certain substances or “biomarkers” linked to cancers. How can already serious ill patients and their families sort out the nuances of these drugs and whether they should take them? Some specialists refer to doctor-patient discussions about late-stage, experimental treatment as “desperation oncology.”

As the independent Kaiser Health News Service has reported:

“Pushed by patient advocates who want earlier access to medications, the FDA has approved a flurry of oncology drugs in recent years, giving some people with cancer a renewed sense of hope … A few of these drugs have been clear home runs, allowing patients with limited life expectancies to live for years. Many more drugs, however, have offered patients only marginal benefits, with no evidence that they improve survival or quality of life, said Dr. Vinay Prasad, assistant professor of medicine at the Oregon Health and Science University, who has written extensively about the FDA’s approval process for cancer drugs. Overall cancer survival has barely changed over the past decade. The 72 cancer therapies approved from 2002 to 2014 gave patients only 2.1 more months of life than older drugs, according to a study in JAMA Otolaryngology–Head & Neck Surgery. And those are the successes.”

Just how grim have the soaring costs of cancer care become? Specialists call it the financial toxicity of cancer care. As the cancer society describes this giant issue:

“Cancer is one of the most expensive medical conditions to treat in the United States. Cancer patients may receive multiple types of treatments, including surgery, radiation therapy, and systemic treatment, and may be hospitalized. Cancer patients with health insurance are paying higher premiums than in the past. They are also paying more for copayments, deductibles, and coinsurance. Compared to 10 years ago, patients receive more expensive chemotherapy, immunotherapy, and other new types of treatments.

“Copayments for prescription drugs covered by health insurance may be more for higher priced drugs or brand name drugs (versus generic drugs) and may increase over time. These copayments and coinsurance for drugs may cause financial toxicity even for cancer patients who have health insurance. Cancer survivors may have financial problems many years after they are diagnosed. This is because they may be paying for ongoing cancer treatment or care for late effects from their treatment.”

A recent Associated Press report, which was highly positive about an emerging cancer treatment involving the novel use of a gene therapy known as CAR T, epitomized the less-emphasized but huge financial hit that cancer patients and their loved ones can experience. It is not until deep in the article that the reporter discloses that the treatment costs hundreds of thousands of dollars, just for the cancer drug. Readers of the New York Times article on the same subject also will find that patients treated with this therapy see infection-fighting cells in their bodies wiped out and thereafter must receive pricey infusions of protective antibodies. 

In 2016, researchers estimated, the cancer drugs approved each cost an average of $171,000 a year. Researchers for a well-known health and insurance consulting firm found that patients with three common kinds of cancer (breast, lung, and colorectal) had out-of-pocket medical costs ranging from $100,000 to $300,000 four years after their initial diagnosis. Cancer patients, AARP has reported, are 2½ times more likely to declare bankruptcy than healthy people, but those patients who go bankrupt are 80% more likely to die from the disease than other cancer patients.

It’s such great news when the doctor says — often five years or so after diagnosis — that you have “beat” cancer. To be clear, though, this message comes with important distinctions. Clinicians may advise patients there are no traces of their cancer, and it will not return. Or they may decide the signs and symptoms of the disease have diminished, so the patient is in remission — partial or complete (with all signs and symptoms of a cancer gone).

With increasing numbers of patients surviving cancer for longer periods, medical science is getting a clearer picture of the disease’s longer-term effects and what they may mean for individuals’ health. As one study published in a medical journal reported:

“Adverse effects of cancer treatment are well documented. Cardiac toxicities are a known complication of specific chemotherapeutics used in breast and other solid tumors, leaving many cancer survivors with degrees of heart failure. Radiotherapy in patients with breast cancer has been linked to an increased risk of coronary events. Impairment of renal function is a complication of certain cancer treatment regimens, often resulting in acute damage and chronic kidney disease. Patients with cancer also face an increased risk of second primary malignancies. For example, a meta-analysis found that patients treated for Hodgkin’s lymphoma are at increased risk of developing second primary lung cancer. A study of testicular cancer survivors found that, compared with surgery only, radiotherapy below the diaphragm significantly increased the risk of second primary cancers or cardiovascular diseases.”

Other sources, including online information provided by academic medical centers  respected for their cancer care, say surviving patients may struggle with disfigurement from radiation or surgery. They may have sustained pain, lasting cognitive harms, and sexual dysfunction. But there also is this from that published research from experts on managing patient care:

“Our study results show a marked improvement in cancer survivors’ well-being in the long term compared with the first 4 years after diagnosis. Moreover, long-term cancer survivors fared at least as well as average U.S. residents across a variety of well-being measures, controlling for demographics and the number of comorbidities.”