In the presidential debates we’ve recently been re-exposed to the phrase “carpet bombing.” This phrase typically means saturation bombing, which indicates large in-flight bombing done in an advanced manner that is intended to inflict maximum damage in every part of a selected area. It’s kind of like covering the floor with a carpet, but with much different results. This type of bombing was done periodically in World War II and the Vietnam conflict, and the results were as you might expect. Unless humans were tucked away in a bomb shelter or were exceptionally lucky, they were annihilated in these bombing runs.
Now, let’s take a look a cancer treatment. I’ve been listening to and working with individual physicians and researchers who have decided that carpet bombing their patients may not be the best course of treatment anymore. For example, it wasn’t that many years ago that the typical treatment of breast cancer was a complete mastectomy, then chemotherapy and radiation, a very real form of medical carpet bombing.
The new movement in medicine is heavily tilted toward personalizing each patient’s care plan to their individual make-up. For example, one genetic test, called pharmacogenomics, can indicate the patient’s ability to metabolize certain medicines. That way, if you’re that one in one thousand person who shouldn’t have a specific type of medication, you’ll know in advance, and that knowledge might keep you from not experiencing sickening side effects to something that is critical to saving your life.
Although these tests have been available for quite some time, their use has been limited because of a lack of training for physicians, a lack of techs to run the equipment, and a complete lack of interpretive skills after the test is administered. All of those areas of concern are being aggressively addressed and will result in these tests becoming available within a very short time.
The really interesting news is that genetic testing of tumors is driving personalized medicine in radiation oncology, too. A recent study that used a genetic test to assess radiation sensitivity of primary tumors and metastases suggests potential for genetic testing to help guide radiation therapy, too.
We know that patients have different clinical responses to radiation, but the way we treat them doesn’t acknowledge that difference. Researchers at the Moffitt Cancer Center and Research Institute in Tampa, Florida, are focusing on integrating genetic measures into radiation oncology so as to begin to understand the mechanisms of how to treat patients more effectively.
So, if we take that example of carpet bombing the disease but apply stereotactic breast biopsy, lumpectomy, and genetic testing to determine what type of drug will not only be tolerated but will also be the best treatment for the patient, and add similar genetic testing to determine radiation efficacy, we will begin to make real personalized progress.
Here’s some even more radical information, however. Your circadian rhythm can impact the effectiveness of your chemotherapy. Dr. Kevin Block has found that the actual time of day that the chemo is administered can impact curative rates up to as much as 25 percent more positively. So, let’s add the following integrative approaches as well:
- Comprehensive Integrative Assessment for Individualizing Treatment & Care – addressing patient profiles and treatment plans
- Therapeutic Nutrition Program with Exchange System and Individualizing to Disease, Clinical, Drug and Laboratory Parameters
- Personalized Physical Care Plan including fitness, manual therapy, acupuncture/acupressure/hyperthermia/cryotherapy
- Personalized Biobehavioral Care Plan
- Optimization of Circadian Health
Now we’re talking about personalized cancer care that should be available to everyone, but based on the speed of science compared to the speed of acceptance, we’re still probably years away, and that is my frustration. Science should be translational, and unless or until we can speed up the marriage of science and medicine, many of our loved ones will suffer unnecessarily.