The Missing Perspective in Personalized Cancer Care
?Vienna, Austria—The identification of genetic mutations and tumor biomarkers to select the right drug for the right patient are not enough to satisfy the need for personalized cancer care, according to Kathy Redmond, MSc, RN, Editor of Cancer World magazine, a publication of the European School of Oncology and former president of the European Oncology Nursing Society, who addressed the topic of personalized medicine at the 2012 European Society for Medical Oncology Congress.
Ms Redmond maintains that genomic profiling does not go far enough to justify the concept of personalized care in cancer. “I use the term ‘personalized cancer care.’ I deliberately do not use the term ‘personalized medicine,’” she said.
“We maintain that personalized medicine will eventually be delivered to all cancer patients. There has been so much hype around the term ‘personalized medicine’ that we lose sight of the fact that we should be focusing on the personalized care of the whole individual,” Ms Redmond argues.
Tailored treatment has been the standard for some time, she says, and this includes not just drugs but type and extent of surgery, radiotherapy, and the like. What is missing is more personalized psychosocial care.
“We know all our patients differ in terms of their age, their tumors, their mutations, their baseline health status, and their access to care, and they come with different attitudes, values, and beliefs about cancer. Some live far distances away from treatment centers. Some are retired….All these things influence their willingness to accept certain cancer treatments,” she says. Rather, the focus should be on the total care of the patient, above and beyond what is considered “core medicine.”
Will Personalized Medicine Be Available to All?
The landscape of cancer is becoming populated by a growing number of subtypes for every tumor, marked by multiple genetic mutations. “And on top of this we have hundreds of rare cancers, with many subtypes as well,” Ms Redmond says. More mutations will be found every day in different grades and stages of disease, she predicted.
“Some of these mutations will be druggable and others not,” she suggests. “In fact, mutation status may not be relevant for many cancers and many patients.” In addition, “the reality today is that there are very, very few targeted drugs on the market, and they are delivered effectively to very few cancer patients.”
“We are at an exciting moment in time. We are starting to win the war on some cancers. But for the vast majority of patients, personalized medicine, that is, the effective use of targeted agents, is not delivering,” she maintains. “We need to be more careful of how we talk about personalized medicine, and we probably need to move the discussion to ‘personalized cancer care’ where we talk about the many aspects of the individual.”
“We often look at the cost of cancer to society, but not necessarily the cost to the patient,” she says. “At the end of the day, it’s the patients we should be focusing on, and putting them at the center of all that we do.”