5 ms·

A close family member has stage 4 cancer. Even if the absolute death rates for some cancers are relatively unchanged, one of the amazing things I’ve observed i

A close family member has stage 4 cancer. 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).

throwaway894345 5y ago
One of the interesting developments is precision medicine: we can now use genomic sequencing and AI to "search" for the treatment that is most likely to be effective against a particular individual's cancer rather than following the rough "standard of care" playbook (for example, depending on the type of cancer, the standard of care might be 6 months of chemo, and if that doesn't work try something else, repeat until cancer goes away or patient dies). The precision medicine approach at this point seems to be among the things that we try if the standard of care doesn't work, but hopefully one day it will be step one (chemo sucks and it is an expensive use of precious time). In addition to searching for treatments, we can also search for clinical trials for which a patient is a good fit--this helps both the research side (it's very hard to find qualified patients) and possibly patients who don't have better options (and of course the research itself benefits future cancer patients).
- gregwebs 5y ago
  > repeat until cancer goes away or patient dies This sounds very similar to participating in a clinical trial and to me ironically seems to be the opposite of precision medicine. The Nagourney Cancer Institute cultures live cancer cells from the patient to test for what drugs may work. Doesn't work for everyone, but seems more in line with precision. Whereas genomic sequencing hasn't produced the amazing results that were expected.
  - throwaway894345 5y ago
    > This sounds very similar to participating in a clinical trial and to me ironically seems to be the opposite of precision medicine. yes, to be clear this is a description of "standard of care" in which oncologists follow a playbook based on the type of cancer. Precision medicine (as I, a lay person, understand it) involves picking a treatment that is very likely to work based on an individual's genes, the genes of their tumor, their past medical history, and other relevant factors. The idea is to use all available information to identify the treatment that is the most likely to succeed for that individual.
  - chefkoch 5y ago
    > The Nagourney Cancer Institute cultures live cancer cells from the patient to test for what drugs may work. That assumes you have time for this. Very often treatment is started within days or even hours of diagnosis.
- hanniabu 5y ago
  This sounds like something insurance will either refuse to cover for being expensive or make you try 5 other approaches first before agreeing to cover it, at which point it'll probably be too late.
  - throwaway894345 5y ago
    To the extent this is true today, I suspect it's precisely because the precision medicine approach is not yet the standard. I.e., insurance companies want you to do the standard of care, but if/when precision medicine _becomes_ the standard then insurance companies will embrace it (or that's my hypothesis, anyway).
  - xwdv 5y ago
    This is partly why it’s important to save for retirement so you can be well capitalized to fund such treatments on your own if they should become necessary.
  - pilotneko 5y ago
    Small consolation, but I believe GINA should prevent that behavior. https://www.hhs.gov/hipaa/for-professionals/special-topics/genetic-information/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/g...
  - sjg007 5y ago
    Unlikely. It will rule out treatments that are unlikely to work, saving money. What we are seeing is Simpson’s paradox. Genomics and precision medicine allow you to segment populations at a higher resolution then before.
    - riboflavin123 5y ago
      It may rule them out. But many standard-of-care chemo drugs are quite cheap. When I had leukemia, my first rounds of chemo used cheap drugs. (The drugs were far cheaper than the daily hospitalization costs, which was required due to drugs obliterating the immune system.) The insurance company didn't require any oversight into the process. But once the chemo stopped working and a much more expensive treatment was needed, the insurance company became quite a pest. I'm fortunate have saved a lot of money, so I didn't delay treatment until insurance approved it. (The 2-3 weeks between treatment starting and the final approval from insurance may have actually made a difference between life-and-death when dealing with aggressive leukemia.)
- deepzn 5y ago
  Figuring out the costs, and who's going to pay for it is one thing, and it's serious - I hope we find solutions there. But, in terms of being gamechangers, my hope is in 10-20 years we will be able to identify genes causing cancer mutations and use CRISPR to edit them out. All this will need massive breakthroughs in leveraging AI , ML and Big Data. Hope we can put an end to Cancer this century at the latest, would prefer it sooner in my lifetime, but I know this is our (humans) ultimate rival /enemy in the game of Life.
paulpauper 5y ago
for a 40 year old diagnosed with stage 4 cancer ,a few extra years ain't much
- gambiting 5y ago
  Are you kidding me????? My dad was diagnosed with a very rare type of stomach cancer called GIST at 42. The average survivability at that stage for GIST at that time was 6-12 months. Zero patients lived more than 5 years. He was given experimental(at the time) drug called Glivec as it was being tested specifically against GIST and it was literally one of these "there's nothing else, so might as well". He lived another 8 years after that, until cancer came back and the drugs stopped working. When he was first diagnosed I was a teenager, my sister was a child - thanks to this drug he was able to see his kids go into adulthood, and obviously spend 8 more years with his wife. How is that "ain't much"??????
  - scottshamus 5y ago
    I appreciate you taking the time to tell your story. It’s easy to view expensive treatments that only extend someone’s life by a year or two as too costly but those remaining years can be the most important for that person and their friends/family.
  - paulpauper 5y ago
    Consider that a 40 year old today can live 40+ more years. so even 4 extra years with experimental treatments is small relative to potential life expectancy without cancer. 4 years is still optimistic given that stage 4 survival for major cancers instill in the 3-20% range depending on the cancer. Speaking of the number 4, awesome my comment already at -4, which is the cap.
    - angrais 5y ago
      Yes, but cancer is not a solved problem, and so people will get it and eventually die. Also, who cares if people live 40+ years? Those with cancer statistically don't, yet drugs can increase life expectancy. That's the point. An extra day with your loved ones is paradise. Taking a drug and potentially gaining years? Come on mate, it's not a surprise you're being downvoted as your attitude is a disgrace.
chiefofstuffs 5y ago
I'm in a similar situation. Partially have self-serving hope, but agreed that the game is starting to shift. The goal is now to buy enough time with the current drug you can move to the next version. So if you get 3 years from the drug and new ones come out every 2, you might get to die of something else. Also aggregated death rates will always lag if treatments are improving.
- t3po7re5 5y ago
  Yep, its all about staying ahead of the curve

throwaway894345 5y ago

One of the interesting developments is precision medicine: we can now use genomic sequencing and AI to "search" for the treatment that is most likely to be effective against a particular individual's cancer rather than following the rough "standard of care" playbook (for example, depending on the type of cancer, the standard of care might be 6 months of chemo, and if that doesn't work try something else, repeat until cancer goes away or patient dies). The precision medicine approach at this point seems to be among the things that we try if the standard of care doesn't work, but hopefully one day it will be step one (chemo sucks and it is an expensive use of precious time). In addition to searching for treatments, we can also search for clinical trials for which a patient is a good fit--this helps both the research side (it's very hard to find qualified patients) and possibly patients who don't have better options (and of course the research itself benefits future cancer patients).

gregwebs 5y ago
> repeat until cancer goes away or patient dies This sounds very similar to participating in a clinical trial and to me ironically seems to be the opposite of precision medicine. The Nagourney Cancer Institute cultures live cancer cells from the patient to test for what drugs may work. Doesn't work for everyone, but seems more in line with precision. Whereas genomic sequencing hasn't produced the amazing results that were expected.
- throwaway894345 5y ago
  > This sounds very similar to participating in a clinical trial and to me ironically seems to be the opposite of precision medicine. yes, to be clear this is a description of "standard of care" in which oncologists follow a playbook based on the type of cancer. Precision medicine (as I, a lay person, understand it) involves picking a treatment that is very likely to work based on an individual's genes, the genes of their tumor, their past medical history, and other relevant factors. The idea is to use all available information to identify the treatment that is the most likely to succeed for that individual.
- chefkoch 5y ago
  > The Nagourney Cancer Institute cultures live cancer cells from the patient to test for what drugs may work. That assumes you have time for this. Very often treatment is started within days or even hours of diagnosis.
hanniabu 5y ago
This sounds like something insurance will either refuse to cover for being expensive or make you try 5 other approaches first before agreeing to cover it, at which point it'll probably be too late.
- throwaway894345 5y ago
  To the extent this is true today, I suspect it's precisely because the precision medicine approach is not yet the standard. I.e., insurance companies want you to do the standard of care, but if/when precision medicine _becomes_ the standard then insurance companies will embrace it (or that's my hypothesis, anyway).
- xwdv 5y ago
  This is partly why it’s important to save for retirement so you can be well capitalized to fund such treatments on your own if they should become necessary.
- pilotneko 5y ago
  Small consolation, but I believe GINA should prevent that behavior. https://www.hhs.gov/hipaa/for-professionals/special-topics/genetic-information/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/g...
- sjg007 5y ago
  Unlikely. It will rule out treatments that are unlikely to work, saving money. What we are seeing is Simpson’s paradox. Genomics and precision medicine allow you to segment populations at a higher resolution then before.
  - riboflavin123 5y ago
    It may rule them out. But many standard-of-care chemo drugs are quite cheap. When I had leukemia, my first rounds of chemo used cheap drugs. (The drugs were far cheaper than the daily hospitalization costs, which was required due to drugs obliterating the immune system.) The insurance company didn't require any oversight into the process. But once the chemo stopped working and a much more expensive treatment was needed, the insurance company became quite a pest. I'm fortunate have saved a lot of money, so I didn't delay treatment until insurance approved it. (The 2-3 weeks between treatment starting and the final approval from insurance may have actually made a difference between life-and-death when dealing with aggressive leukemia.)
deepzn 5y ago
Figuring out the costs, and who's going to pay for it is one thing, and it's serious - I hope we find solutions there. But, in terms of being gamechangers, my hope is in 10-20 years we will be able to identify genes causing cancer mutations and use CRISPR to edit them out. All this will need massive breakthroughs in leveraging AI , ML and Big Data. Hope we can put an end to Cancer this century at the latest, would prefer it sooner in my lifetime, but I know this is our (humans) ultimate rival /enemy in the game of Life.

paulpauper 5y ago

for a 40 year old diagnosed with stage 4 cancer ,a few extra years ain't much

gambiting 5y ago
Are you kidding me????? My dad was diagnosed with a very rare type of stomach cancer called GIST at 42. The average survivability at that stage for GIST at that time was 6-12 months. Zero patients lived more than 5 years. He was given experimental(at the time) drug called Glivec as it was being tested specifically against GIST and it was literally one of these "there's nothing else, so might as well". He lived another 8 years after that, until cancer came back and the drugs stopped working. When he was first diagnosed I was a teenager, my sister was a child - thanks to this drug he was able to see his kids go into adulthood, and obviously spend 8 more years with his wife. How is that "ain't much"??????
- scottshamus 5y ago
  I appreciate you taking the time to tell your story. It’s easy to view expensive treatments that only extend someone’s life by a year or two as too costly but those remaining years can be the most important for that person and their friends/family.
- paulpauper 5y ago
  Consider that a 40 year old today can live 40+ more years. so even 4 extra years with experimental treatments is small relative to potential life expectancy without cancer. 4 years is still optimistic given that stage 4 survival for major cancers instill in the 3-20% range depending on the cancer. Speaking of the number 4, awesome my comment already at -4, which is the cap.
  - angrais 5y ago
    Yes, but cancer is not a solved problem, and so people will get it and eventually die. Also, who cares if people live 40+ years? Those with cancer statistically don't, yet drugs can increase life expectancy. That's the point. An extra day with your loved ones is paradise. Taking a drug and potentially gaining years? Come on mate, it's not a surprise you're being downvoted as your attitude is a disgrace.

chiefofstuffs 5y ago

I'm in a similar situation. Partially have self-serving hope, but agreed that the game is starting to shift. The goal is now to buy enough time with the current drug you can move to the next version. So if you get 3 years from the drug and new ones come out every 2, you might get to die of something else. Also aggregated death rates will always lag if treatments are improving.

t3po7re5 5y ago
Yep, its all about staying ahead of the curve