Death rates are declining for many common cancers in the U.S., report finds

My oncologist was great (ucsf medical center) - but the surgeon refused to address my liver mets - they were too large and distributed.

My wife found out about a specialist at Sloan-Kettering in Manhattan that uses something called a Hepatic Arterial Infusion Pump - a hockypuck that delivers 50x a chemo dose directly to the liver. That was implanted in my abdomen and I flew between SF and New York to get it refilled every 4 weeks for six months. Their surgeon then resected 75% of my liver. (Skipping a few steps here. I had another met that they couldn’t get surgically and they got it with 10 rounds of radiation.)

My company was very supportive and our health insurance picked up most of the cost - over US $2million (so far?)

I was hospitalized several times after the surgeries for post operative infections - in a way they seemed far more difficult for the doctors to address than the cancer itself.

Oh, while the Cetaximab shrank the tumors, the skin rash it caused was absolutely wretched - my cuticles would bleed and had to wear finger cots and gloves to protect them. And my eyelashes grew about 3x their normal length.

[1] https://news.ycombinator.com/item?id=8095321

Even if the absolute death rates for some cancers are relatively unchanged, one of the amazing things I’ve observed is that medical advances have increased the long term survival rates of terminal/metastaticized cancers. It’s partially due to the development of various drugs that have been identified as effective against various specific mutations. Even if the cancer is incurable with existing technology, they can extend lives by years, which is nothing to sneeze at. Especially considering many people get diagnosed with cancer once they are elderly already, it can mean the difference between dying directly of cancer and living long enough to die of something else - ie the cancer becomes something more like a chronic condition than it does a direct threat (for a period of time).

These treatments cost about $100K - $150K per year. They don't work for everyone, or even the majority of people with melanoma and lung cancer. Generally they result in 15 - 20% of patients with otherwise fatal cancer having long term disease control, and some lesser percentage that are probably cured from the incurable. They require sepcialist multidisciplinary oncology care. There can be severe and permanent side effects, but these are almost aways preferable to being dead from cancer.

It is important to note that these drugs do not work well or at all for the most common cancers with large shares of overall cancer mortality (Breast, Prostate and Colon), so this decline in mortality isn't going to automatically continue year over year. Also note that lung cancer is still the number one cause of cancer mortality, and this is due to smoking. So although we should celebrate great science and fancy expensive drugs, always remember that lung cancer is a disease caused by our failure to think clearly about corporate ethics and healthcare. Big tobacco is remarkably profitable and that is solely because we agree to pay in cash and lives for the negative externalities of their product.

Example: when I was younger the 5 year survival rate for malignant melanoma was about 5%. Now? Significantly better [1].

[1]: https://www.google.com/amp/s/amp.cancer.org/cancer/melanoma-...

Perhaps the most interesting tidbits here are regarding the increases in mortality from particular cancers, which seem in most cases to be related to increasing numbers of diagnoses of the relevant cancer types.

Quote: Ozlem Tureci, who co-founded the German company BioNTech with her husband, was working on a way to harness the body’s immune system to tackle tumors when they learned last year of an unknown virus infecting people in China. ... [T]he couple decided to apply the technology they’d been researching for two decades to the new threat. ...

As BioNTech’s profile has grown during the pandemic, so has its value, providing funds the company can use to pursue its original goal of developing a new tool against cancer.

“We have several different cancer vaccines based on mRNA,” said Tureci, who is BioNTech’s chief medical officer.

Asked when such a therapy might be available, Tureci said “that’s very difficult to predict in innovative development. But we expect that within only a couple of years, we will also have our vaccines [against] cancer at a place where we can offer them to people.”

https://www.timesofisrael.com/scientist-behind-pfizer-vaccin...

Quote: The vaccines that target tumor-associated or tumor-specific antigens (TAAs or TSAs) can specifically attack and destroy malignant cells that overexpress the antigens and achieve chronic therapeutic response because of immunologic memory. Therefore, cancer vaccines offer specific, safe, and tolerable treatment compared to other immunotherapies.

https://molecular-cancer.biomedcentral.com/articles/10.1186/...

I saw bits of it in my space with large scale analysis of genomic testing - particularly things like analyzing old drugs with new genomic data (drugs which failed in the past, retesting for the combo of the cancer:personal-genome SNPs).

My friend went through a Car-T recently for a lymphoma and something like that is near SciFi-tech in discussion when Steve Jobs had cancer, but available through the FDA today.

[1] - https://www.cancer.gov/research/key-initiatives/moonshot-can...

I am thankful for vaccines. If they can stop the cancer before it gets you and me I will be thankful for that as well . I think that people have been hoping for a cure for a long time. I am not optimistic that there will be a cure in time for me, but I hope just like everyone else.

Here is the link to the actual report: Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics (PDF only) [0]

[0] <https://academic.oup.com/jnci/advance-article-pdf/doi/10.109...>