Medical advancesCancer is becoming a chronic disease rather than a sudden acute illness eased only by death. Sylvia Thompson reports
It used to be called "the big C" but even such a euphemism didn't lessen the profound shock of a cancer diagnosis, the chilling fear of treatment and the all-encompassing terror of a sudden and painful death.
But now the picture is changing and while cancer specialists still speak of the "long and arduous journey" through treatment, earlier diagnosis, coupled with a more targeted multi-faceted therapeutic approach, is seeing the death rate for certain cancers reduce significantly.
In some cases, cancer is becoming a chronic disease, the shadow of which patients learn to live with rather than suffering a sudden acute illness eased only by palliative care and the spiritual acceptance of imminent death.
And while the number of cancer cases in the Republic continues to rise, deaths from cancer are increasing at a much slower rate.
Cancer services are also slowly becoming better co-ordinated as multi-disciplinary teams (made up of medical oncologists, surgeons, radiation oncologists, cancer nurse specialists and others) become more widely accepted as the best way forward.
Recent appointments of medical oncologists (12 posts since 1997), radiotherapists (13 radiotherapists since 1997) and surgeons (15 cancer surgeons since 1997) have been widely welcomed in spite of the justifiable call for more cancer services (particularly radiation treatment) in the weeks preceding local elections.
Speak to any cancer specialist and you'll quickly sense a quiet optimism for the future treatment prospects of many newly diagnosed cancer patients. This optimism is founded on new strategies for a more co-ordinated system of care for cancer patients but much more so on the arrival of new cancer drugs.
These drugs - some of which are available to Irish patients participating in clinical trials - target specific biochemical processes within cancer cells and, in so doing, offer some cancer patients much better rates of recovery than previously expected.
"There are new hormonal drugs known as aromatase inhibitors [which block the enzyme, aromatase, which blocks further oestrogen production\] which now look like they may be superior to the drug Tamoxifen for breast cancer," says Dr John Kennedy, consultant medical oncologist in St James's Hospital, Dublin.
"Although their exact role is continued to be defined, they are widely used by patients with advanced breast cancer and are starting to replace Tamoxifen in the early stages of breast cancer.
"They might even have a role in the prevention of breast cancer," he says.
As late diagnosis is still the main reason for death from the disease, the value of these new cancer drugs will only really be seen when treatment is coupled with earlier diagnosis. And early diagnosis depends both on cancers being picked up through population screening programmes such as BreastCheck and GPs offering patients diagnostic tests for any unusual symptoms that cannot be otherwise accounted for.
"The greatest advances have been in diagnosis with CAT scans and ultrasound scans. The advances in therapeutics have lagged behind," continues Dr Kennedy. "The advances in the understanding of the biology of cancer is breath-taking and the advances in treatment reflecting this knowledge is beginning to happen. We are seeing the first fruits of the molecular medicine revolution in cancer treatment now."