Curious Dr. George | Plumbing the Core and Nibbling at the Margins of Cancer

Patient-Reported Outcomes Could Transform Cancer Care

A Q&A with Jared Adams MD, PhD, Chief Science Officer at Self Care Catalysts;
Q: Patient-reported outcomes (PROs) are health care outcomes, such as symptoms or quality of life, reported directly by a patient. In recent years, PROs have emerged as a potentially powerful new way to understand cancer outcomes. Could PROs lead to the next breakthrough in our understanding of cancer?
A: When biochemist and Nobel Prize winner Kary Mullis spoke to my undergraduate class some 20 years ago about his invention of the PCR method for genetic amplification, he put it in historical context by mentioning that every major clinical advance has been preceded by a breakthrough in scientific investigative methods that allowed us to “see” in new ways. Dutch scientist Antonie Van Leeuwenhoek’s microscope allowed scientists to see cells for the first time, advancing us beyond the notion of cancer being caused by an abundance of black bile. The PCR method allowed us to see and manipulate cancer at the genetic level, leading us down the road to targeted therapies aimed at specific genetic mutations. Advances in computer hardware and modeling techniques have allowed us to map the genomes of cancers, moving us beyond a simplistic organ-based model of disease and setting up the possibility of new drug discoveries in silico. Observing and understanding how cancer cells interact with circulatory and immune systems led to VEGF inhibitors, PD-1/PD-L1 inhibitors, and the list goes on…
As our understanding of cancer grows to include larger and more complex systems, we should start to pay serious attention to how cancer interacts with systems outside the human body; its ecology, so to speak. In the last decade cancer researchers have drawn inspiration from studying how invasive species, such as the zebra mussel, take root and overwhelm the ecology of native systems. The word “ecology” comes from the Greek oikos, meaning “home” or “place to live,” and relates cancer to its organic and inorganic environment; not just within the host, but the environment of the host itself. We’ve known for some time how specific exposures to pathogens and substances can influence the rates of specific cancers and how diet, activity, and social network can in some cases influence cancer rates and outcomes.
However, through smartphones, wearables, and integrated sensors, tools to capture PROs are becoming more mainstream and sophisticated in their ability to record granular details about a person’s environment, routine, exposure, and more. Such advancements may be opening up a new era where these details become as important to prognosis and treatment decision making as clinical metrics like cancer stage and genetic profile. Just as we are entering a new era of cancer disease classification based not on primary location but on genetic profile and targeted therapy response, the next sea change may be classifying cancers by their relation and responsiveness to environmental variables and self-care behaviors. Human behavior is complex, but if privacy and regulatory considerations can be worked out and financial incentives aligned, the technology and tools exist to understand it and cancer in a way that’s only been hinted at in epidemiology and health services research up to now.
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