Cancer and Society: A Multidisciplinary Assessment and Strategies for Action

186 Pages·2019·3.308 MB·English

by  Eric H. Bernicker

Cancer and Society
A Multidisciplinary Assessment
and Strategies for Action
Eric H. Bernicker
Editor
123
Cancer and Society
Eric H. Bernicker
Editor
Cancer and Society
A Multidisciplinary Assessment
and Strategies for Action
Editor
Eric H. Bernicker
Cancer Center, Houston Methodist Hospital
Houston
TX
USA
ISBN 978-3-030-05854-8 ISBN 978-3-030-05855-5 (eBook)
https://doi.org/10.1007/978-3-030-05855-5
Library of Congress Control Number: 2019932848
© Springer Nature Switzerland AG 2019
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Foreword
In the last decade, we have seen remarkable improvements in human health across
the globe. These gains have been largely due to our successful efforts in combatting
infectious diseases. With declines in deaths due to HIV, tuberculosis, malaria, and
childhood diarrhea and pneumonia in every region of the world, we are seeing shifts
in the global disease burden and leading causes of mortality. However, as infectious
diseases retreat, the noncommunicable diseases (NCDs) are rising to take their
place—including most forms of cancer. Grouping all types together, cancer is the
second leading cause of death worldwide—and about half of these are considered
“premature deaths” (avoidable had screening or treatment been available). This
translates into about nine million deaths each year, equaling nearly one-quarter of
all deaths. The majority, more than 70%, occurred in low- and middle-income coun-
tries (LMICs). And concerning trends in these countries indicate that NCDs are
rising faster, affecting younger age groups, and resulting in worse outcomes.
Many factors are contributing to this alarming shift in global disease burden.
First, populations in every region of the world are living longer. Currently, in low-
and middle-income countries, average life expectancy is into the 60s, with an over-
all global average of 70 years for males and 74 years for females. A predictable
consequence of this desirable trend is that, as populations age, the disease burden
and distribution necessarily shift toward NCDs. Simultaneously, important changes
seen in diet and lifestyle have occurred in recent years due to rapid urbanization and
subsequent changes in livelihoods and social structures. As diets become more
“Westernized” with more processed, high-fat foods and fewer fruits and vegetables,
lifestyles become more sedentary, and the use of both tobacco and alcohol increases,
it is no surprise that rates of diabetes and obesity are climbing and, along with these
conditions, rates of cardiovascular disease and cancer. Lastly, infections such as
hepatitis and human papilloma virus also contribute to the rise of their associated
cancers, being responsible for approximately one-quarter of cancers in LMICs.
Taken together, these dangerous trends are threatening our ability to reach several of
the Sustainable Development Goals.
Cancer carries the additional challenge of being a heavily loaded term. It was not
that long ago that people were afraid to say it out loud—even a speculative cancer
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vi Foreword
diagnosis was discussed in hushed voices, behind closed doors, and often only with
immediate family members, never with the person experiencing the disease. Even
today, the word cancer instills fear and dread in the minds of most people, even
those in wealthy communities who have access to comprehensive and cutting-edge
treatment. In poorer communities where cancer care access is not guaranteed—
either in the USA or elsewhere—the odds rarely seem to be in one’s favor.
Recognizing that in LMICs, 9 out of 10 patients with a cancer diagnosis will die, it
is no wonder that patients wait to seek care, afraid of facing the outcome they
believe is inevitable any earlier than they have to, completely unaware that earlier
detection and treatment may lead to a greater chance of survival, thus reinforcing
the “cancer = death sentence” paradigm.
Today our world is more connected than ever before through business, travel, and
numerous social media platforms. Among other things, these connections have led
to a greater recognition of the health inequities that exist across the globe. A better
understanding of how cancer risk and care occurs on our currently uneven global
playing field is critical for understanding the underlying issues to the growing can-
cer burden and why we cannot continue business as usual if we want to change the
current trajectory—in this country and across the globe. In all settings, rising cancer
rates will be driven by the unequal economic development that targets the poor and
other historically vulnerable communities across the globe. The important influence
that the social determinants of health—factors such as socioeconomic status, educa-
tion level, social integration, and support systems, as well as one’s physical environ-
ment and neighborhood—have on ability of individuals and populations to reach
their optimal health has been well described. Those with the fewest resources and
least clout will suffer the greatest negative consequences. Therefore, applying a
social justice frame is necessary to best understand the factors that contribute to the
uneven distribution of cancer morbidity and mortality and to inform strategies that
address these multifactorial, complex health, and public health challenges.
Delving into the health equity issues associated with the current cancer burden
and delivery of care and prevention services, it is tempting to focus on issues of
access to cancer treatment. Clearly, this is a critical issue given that many of today’s
cancer medications are prohibitively expensive and therefore out of reach for most of
the world’s cancer patients. In fact, less than one-third of LMICs report having can-
cer treatment services available. Yet issues of equity extend well beyond drug prices.
Access to healthcare generally and cancer screening in particular becomes relevant.
And beyond health and healthcare services, the impact of broader social and environ-
mental factors that affect cancer risk must be closely explored. These include increas-
ing urbanization and air pollution, global changes in climate that disrupt agricultural
systems and yield less nutritious food crops, and greater exposure to carcinogenic
environmental toxins such as pesticides, lead, and volatile organic compounds that
are the by-products of natural resource extraction—and how those living in poorer
communities and nations are going to bear the brunt of these increased risks. In addi-
tion to environmental changes, consider the targeting advertising of tobacco and
alcohol toward LMIC markets where the requirements for health warnings are non-
existent and you have the perfect storm for the growing cancer pandemic.
Foreword vii
Cancer care and prevention is a complex global health challenge and will require
a multisectoral approach if we are going to reverse current trends or reach World
Health Organization targets such as a 25% reduction in the rate of premature cancer
deaths globally by 2025, along with other NCDs. Improvements in data collection
and surveillance, typically in the form of comprehensive cancer registries will be
necessary to help quantify the magnitude of the problem and inform national health
policymakers in allocating limited resources. Replicable and scalable models of
cancer care and prevention need to be shared widely with plans for broader imple-
mentation. The current situation in care and prevention is a clarion call for those of
us engaged in global health to take action through advocacy, capacity building, and
equity-driven research. There is no alternative if our vision is a world with health
equity for all.
Lisa V. Adams
Associate Professor of Medicine
Associate Dean for Global Health
Dartmouth Geisel School of Medicine
Hanover, NH, USA
Preface
Current developments in therapeutics for cancer therapy have led to increasing opti-
mism regarding treatment success. Developments in immunotherapy as well as
rapid advances in DNA sequencing and genomics have led to an unprecedented
expansion of therapeutic targets. Many patients with metastatic cancer are now
going into remission and living longer than at any time in the past. While many
patients do not respond to these new innovative therapy and others who do eventu-
ally develop acquired resistance, the success achieved thus far have encouraged
cancer researchers that significant clinical advances will continue to accrue.
Despite these impressive scientific achievements, many public health issues that
intersect directly or indirectly with cancer as a field remain problematic. Tobacco
use, while much lower in the west than 40 years ago, continues to be a public health
scourge in the developing world; it is estimated that tobacco will cause a billion
deaths in this century. Pollution is being recognized as a growing health hazard that
especially affects the health of low-income communities, especially in the global
south. Access to care remains problematic in both the USA and in low- to mid-
income countries. Drug expense remains an impediment to maximizing patient
access, and financial toxicity remains a burden that cancer patients and their fami-
lies have to shoulder, often for years following therapy. These issues both contribute
to suffering of current cancer patients and often unfortunately lay the groundwork
for the next generation of people who will be facing advanced malignancies.
Many oncologists and cancer researchers are more than busy focusing on their
patients and narrow field of scientific investigation. However, if we take a broader
view, this same group is uniquely positioned to make significant contributions to the
discussion of how to best address broader issues where the field of cancer medicine
overlaps with other problems facing society. Whether it is reassuring the public that
the same scientific methods that have brought these significant clinical advances
also are used to confirm anthropogenic climate change or continuing to lead advo-
cacy efforts to limit tobacco use, these pressing societal problems need to be
addressed by physicians on the frontline of patient care.
With aging populations, increasing documentation burden, and a well-publicized
physician burnout crisis, why should healthcare professionals involve themselves in
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x Preface
larger public health issues? Who has the time to lend their expertise and their voices
to significant social issues facing society? I would argue that there are three major
reasons.
Firstly, being involved in efforts to improve the public good can definitely serve
as a bulwark against burnout and cynicism and infuse significant meaning that can
complement the work that providers do in the lab or in the clinic.
Secondly, cancer scientists often are well regarded by the public, and they need
to leverage their scientific bully pulpit, so to speak, to help inform and guide the
public on the weight of evidence-based science that can inform social and political
action. Whether that is discussing climate change or environmental pollution or gun
control, we can bring a measured discussion of data and how to interpret it that is
becoming more important and yet more elusive to our civic discourse.
Lastly, we all have a responsibility to work toward human flourishing and make
sure that the future generations of life on this planet—and not just human life—can
partake in the joys of living in the world. Cancer physicians and researchers under-
stand all too well how biological systems can go awry and damage life; working to
minimize tobacco or pollution or climate change is a way of limiting the damage to
the biosphere and should help increase the odds of a healthy future for humanity.
This topic can be vast; we have selected only a number of pressing issues to
address looking at the intersection public health and cancer as well as framing cer-
tain questions by looking at cancer patients as a vulnerable group. It is our hope that
these essays will inspire oncologists and cancer researchers to occasionally look
beyond the walls of the clinic and get involved—by bringing their knowledge and
passion—in addressing societal issues so that we will have fewer cancer patients in
future generations, not more.
Houston, TX, USA Eric H. Bernicker
Contents
1 Tobacco and Social Justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Eric H. Bernicker
2 Climate Change and Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Nathaniel T. Matthews-Trigg, Jennifer Vanos, and Kristie L. Ebi
3 Pollution, Cancer Risk, and Vulnerable Populations . . . . . . . . . . . . . . . 27
Megan E. Romano, Olivia J. Diorio, and Mary D. Chamberlin
4 Causes, Consequences, and Control of High Cancer
Drug Prices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Bishal Gyawali
5 Clinical Trials: Not for the Poor and the Old . . . . . . . . . . . . . . . . . . . . 59
Mary K. Clancy
6 Global Disparities: Can the World Afford Cancer? . . . . . . . . . . . . . . . 79
Haydee Cristina Verduzco-Aguirre, Enrique Soto-Perez-de-Celis,
Yanin Chavarri-Guerra, and Gilberto Lopes
7 Cancer Quackery and Fake News:
Targeting the Most Vulnerable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
David H. Gorski
8 The Adoption of Artificial Intelligence in Cancer Pathology
and Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .113
Stephen T. C. Wong
9 The Hippies Were Right: Diet and Cancer Risk. . . . . . . . . . . . . . . . . . .121
Renee E. Stubbins and Eric H. Bernicker
10 Protons and Prejudice: Finding Sense and Sensibility
in the Development of a Costly Medical Therapy . . . . . . . . . . . . . . . . . 131
Andrew M. Farach
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