Article: A Promise to My Sister: Continuing the Fight Against CancerAuthor: Srikant Ramaswami
Date: Srikant Ramaswami
The American Society of Clinical Oncology (ASCO) is holding its annual meeting in Chicago. Founded in 1964, ASCO is the world’s leading professional organization for physicians and oncology professionals caring for people with cancer.
In 2017, nearly 40,000 professionals, exhibitors, and international attendees participated at their annual meeting. The top 10 countries represented at that meeting include the United States, Japan, Germany, France, United Kingdom, China, Canada, Brazil, Switzerland and Italy, confirmation that cancer is geographically agnostic and affects us all.
As in years past, this year’s ASCO conference is comprising workshops, plenary sessions, poster presentations, and exciting discussions around new cancer treatments.
The atmosphere will be electric, for there is a job to be done – a problem to be solved. In 2018, according to the American Cancer Society, about 1.7 million new cancer cases are expected to be diagnosed, and more than 600,000 Americans are expected to die of the disease this year. In fact, cancer kills more Americans every year than any other disease except heart disease.
While lifestyle changes, smoking cessation programs, and wellness prevention are proving fruitful, we must find an imminent cure for this debilitating and devastating disease.
For me, curing cancer is deeply personal. It has affected my family, my closest friends and people I love deeply. More than six years ago, I lost my sister Brinda to metastatic breast cancer.
While white and red blood cells engaged in internecine conflict within her weary body, she had irredentist claims on life. She wanted to see her children grow and be successful. She hoped to be around to celebrate many future birthdays, anniversaries and weddings.
Unfortunately, this was not to be. Like so many, so young, she was gone. And to watch my elderly parents, her husband, and her young children crumble with visceral sadness is a sight no one should have to endure.
Cancer is a dirty word. A bad word. It can damage your faith, destroy your dreams and devastate your family. Through the countless doctor’s appointments, the radiation and chemotherapy, the surgeries and the follow-ups, Brinda braved it all, wanting to live desperately.
Brinda was a fighter. She fought battles and won wars. She was determined to be a role model for the medical community. She told me, in her final weeks, that she would be THE patient testimonial; THE late-breaker at ASCO.
My sister was fortunate in some respects. She had many of the top oncologists attend to her including Clifford Hudis, M.D. FACP, FASCO, now CEO of ASCO.
Dr. Hudis served for nearly two decades as the Chief of the Breast Medicine Service and Attending Physician at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York City, where he was also a Professor of Medicine at the Weill Medical College of Cornell University. He was co-chair of the Breast Committee of the Alliance for Clinical Trials in Oncology (formerly Cancer and Leukemia Group), Chair of the Scientific Advisory Committee of the Breast Cancer Research Foundation, a former Associate Editor of the Journal of Clinical Oncology, and the President of ASCO during its 50th anniversary year, 2013-2014.
When I met him for the first time, he was intriguing. His knowledge of the disease was expansive; his confidence and compassion were hallmarks of passion, perseverance and purpose.
Dr. Hudis is a remarkable man and a genius oncologist. Even today, he is quick to return an email when I ping him about a friend or family member. With Dr. Hudis at the helm of ASCO only great things can happen for the future of cancer research and treatment. I am more optimistic now than I have ever been that cures are on the way.
In spite of my optimism, I am concerned about the profligate cost of cancer treatment. I understand the arguments made to justify why medicine costs so much. But we have to try harder. We have to do more. If medicines that are truly innovative cannot be accessed by most, what are we trying to solve?
The Agency for Healthcare Research and Quality estimates the direct medical costs (total of all health care expenditures) for cancer in the U.S. in 2015 were $80.2 billion. Fifty-two percent of those costs were for hospital outpatient or office-based provider visits, and 38 percent were for inpatient hospital stays.
Lack of health insurance and other barriers prevents many Americans from receiving optimal cancer prevention, early detection and treatment. According to the U.S. Census Bureau, 28 million Americans (9 percent) were uninsured during the entire 2016 calendar year, down almost 14 million from 2013 because of the implementation in January 2014 of several new provisions of the Affordable Care Act.
The largest increase in health insurance coverage was among those with the lowest education and income. Hispanics and blacks continue to be the most likely to be uninsured, 16 percent and 11 percent, respectively, compared to 7 percent of non-Hispanic whites.
Uninsured patients and those from many ethnic minority groups are substantially more likely to be diagnosed with cancer at a later stage, when treatment is often more extensive, costlier and less successful.
As ASCO begins, I think about the Brindas in this world. The Brindas, who sit in the chairs of their oncologists, hoping that remission will turn the tide of their meaningless existence. The Brindas, who at this very minute have received news their biopsy is positive and the road ahead will be arduous, painful and long. The Brindas, who will regrettably and inevitably line the waiting rooms of M.D. Anderson, Johns Hopkins, or Dana-Farber in years to come. The Brindas, who are told by their optimistic physicians, that they will aggressively help them win this battle, appealing to patients’ fears and hopes.
Today, we must commit to finding answers. To do so is not just an aspiration; it is an obligation. We must harness the great scientific minds in the plethora of laboratories across this great country and around the world to identify why we get cancer and how we can stop it.
This is our mandate, and it must be our mission.
Brinda may be gone, but she will never be forgotten. In her honor, and in her name, I will do all I can do to be a vociferous advocate for a cure. And I am hopeful the warriors of wellness come away from this year’s ASCO meeting, filled with renewed passion, persistence, and grit to do whatever is necessary to win, so millions of patients can truly embrace brighter tomorrows.
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