Cancer is the No. 2 cause of death in the U.S., according to a November 2018 report from the National Center for Health Statistics, just behind heart disease, but ahead of Alzheimer’s disease, diabetes, influenza and pneumonia, and other killers.
In the face of that grim reality, health care institutions are trying to find solutions. Dr. Steven Libutti, director of Rutgers Cancer Institute of New Jersey and senior vice president, Oncology Services at RWJBarnabas Health, is helping to lead the charge.
“Approximately 50,000 new cancer cases a year occur in New Jersey, with close to 17,000 deaths,” he said. “Lung cancer is the most prevalent here, as it is nationally. A significant percentage of lung cancer cases are attributed to tobacco, mainly cigarettes, but many victims do not have a direct smoking history, which indicates that smoking is critically important, but not the only driver.”
A complex disease
It’s easy to get discouraged over the resilience of cancer. But Libutti said it’s not that simple.
“We’ve learned how to treat many infectious diseases through antibiotics and vaccinations — although misinformation has driven resistance to vaccines, and we are seeing a resurgence of smallpox and measles — but cancer is made up of many diseases,” he said. “That means there are many drivers, including environmental, genetic, and other exposure risks, so I don’t believe we’ll discover a single ‘magic bullet’ cure.”
Inspira Health is rolling out a new pilot program designed to detect cancer early, when treatment may be more effective.
The health care network plans to perform about 10,000 high-risk cancer assessments using a new platform called Inspira InSight: every woman who has a mammogram at an Inspira location will be encouraged to take a free 10-minute assessment during the visit. “If the assessment raises any red flags, the woman will be connected with our high-risk cancer program,” according to an Inspira announcement. “We view this as a community wellness initiative.”
Inspira InSight uses a digital platform to evaluate patient responses and mammography results against evidence-based guidelines to identify those with a higher than average risk for developing genetically based cancers. Individuals with genetic “red flags” will be offered the opportunity to work with Inspira’s high risk cancer team, which will develop a personalized surveillance or risk-reduction plan to reduce a person’s risk of developing cancer or detect it early.
“Our cancer team meets regularly to plan and discuss each patient’s treatment and progress,” according to an Inspira announcement. “The team includes medical and radiation oncologists, surgeons, pathologists, radiologists and specialists in reconstructive plastic surgery, along with nurse navigators, social workers, genetic counselors, registered dietitians, physical therapists and behavioral health specialists. It is our view that cancer can no longer be treated at a single point in time. Fighting cancer is a lifelong commitment.”
Because of its genetic component, cancer can be inherited. “But we’re also seeing an increase in some tumor types because of behavior, like an increase in smoking among women and other demographics,” Libutti added. “We need better education about risks and need to do a better job of screening smokers. At CINJ, we work closely with the state health department on initiatives like Screen NJ to help detect colorectal and lung cancer.”
Researchers are making progress in areas like colon cancer, he added. “In the early 1990s, it was the third-most common cancer and the second-highest cause of cancer-related death, but now it’s slipped,” to the third-highest cause of cancer-related death. “There’s a realization that colonoscopy screening can offer early detection; while identifying and removing precancerous polyps is also effective.”
As the state’s only National Cancer Institute-designated Comprehensive Cancer Center, CINJ is a kind of one-stop shop, Libutti said. “We research and identify causes, develop treatments, and screen and investigate ways to prevent cancer,” he noted. “In partnership with RWJBH, we’re committed to progress and provide health treatment to nearly half of New Jersey’s population. The partnership plans to expand our programs across the state, so patients won’t have to travel more than 20 minutes to receive exceptional cancer care.”
Hidden in plain sight
Cancer is a particularly frustrating condition, in part because “cancer cells evolve rapidly as they divide, making them a moving target in terms of directing a cure,” said Dr. Nandini Kulkarni, medical director of Surgical Oncology at Inspira Health’s Medical Center Vineland. “Also, cancer cells can hide in plain sight, making it difficult for our body’s immune system to find and fight them. Cancer affects different organ systems differently, making it difficult to find a ‘one size fits all’ cure.”
To help prevent the occurrence of cancer, she’d like to see more “health awareness through statewide and national campaigns,” including efforts aimed at educating people about the dangers of tobacco use and vaping.
“Funding for research at the university and community level is also an important step in improving cancer care for the general populace,” Kulkarni added. “Eating healthy foods with a good balance of fruits and vegetables with limited meat intake, moderate exercise and activity, good hygiene, sun protection, and avoidance of tobacco, excessive alcohol and unprotected sex are just some of the ways in which the average person can improve their health and reduce their lifetime risk of cancer. Besides this, regular self-checks, as well as timely visits with your doctor to get screening exams and tests such as mammograms and colonoscopy empowers the individual to stay ahead of problems. Procrastination paves the way for future pain.”
Reasons for optimism
Finding cures for different kinds of cancer is a challenge. “But at the same time — thanks to novel innovation and a greater understanding of the molecular basis of malignancies — more people are living longer after they’ve had previously fatal diseases,” said Dr. Seth H. Berk, program director at the Penn Medicine-Virtua Cancer Program.
He said the partnership between Penn Med and Virtua offers an “infrastructure that enables us to better address many individual malignancies with a variety of approaches, including radiation oncology [and] kinetics [a study of cell growth]; while nurse navigators, clinical trials, board-certified surgeon oncologists and others all work as a team.”
Berk is optimistic, but his positive outlook is tempered by a desire for the state and federal governments to pony up more support. “One issue is underinsured or uninsured patients,” he noted. “The health care system shouldn’t have hospitals or physicians shouldering the costs of uninsured individuals. The state should also offer these patients more access to tertiary [specialized] cancer care centers.”
There are a very limited number of centers “where the uninsured can receive tertiary care, like bone marrow transplants, but patients may have a very difficult time getting to them,” he added. “Still, any kind of advance comes in steps, building off previous successes and failures.”