Dr Paul Sabbatini, MD, Gynecologic Oncologist, Memorial Sloan Kettering Cancer Center explains to Viveka Roychowdhury how global collaborations in cancer research can bridge the gap in access to quality cancer care. He also elaborates on the pressing need for policy adjustments, like establishing specialised trials tailored for patients with rare cancers, supporting decentralised trials and easing telehealth restrictions to expand access to innovative treatments
As May is Cancer Research Month, how have efforts in cancer research helped more patients prevent cancer and access affordable care in resource-scarce countries like India?
Collaborative efforts in cancer research have been instrumental in revolutionising cancer care and improving access to treatments. One of the most noteworthy aspects of advancements in cancer care due to clinical research is the development of new drugs, innovative procedures, and effective screening techniques. These breakthroughs have not only enhanced the survival rates but have also improved the quality of life for patients with cancer. Additionally, the exploration of new applications for existing drugs has expanded treatment options, making them more precise, accessible, and cost-effective.
Moreover, many of these advancements are broadly applicable across different populations and are readily shareable. This means that the benefits of cancer research are not confined to a particular region but can be disseminated globally. By leveraging these shared advancements, healthcare professionals in such regions can offer cutting-edge treatments and interventions to their patients, thereby bridging the gap in access to quality cancer care.
Can you provide a few real-world examples of how cancer research has translated into tangible patient benefits in India?
A primary source of making the benefits of cancer research in India available to patients is having direct access to clinical trials. A recent survey of the Clinical Trial Registry India (CTRI) showed that clinical trials for solid tumors were more common than those for hematological malignancies and were distributed according to incidence (breast cancer 17 per cent, head and neck cancer 9.8 per cent, lung cancer 9.6 per cent and cervical cancer 6.6 per cent). These trials bring tangible benefits to patients who have access. It was noted that hematological malignancies such as leukemia and lymphoma, and head and neck and cervical cancers were underrepresented when compared to disease burden and there is a general effort to rebalance. Geographic disparities were also noted, and these shortfalls should remain a focus for the future.
India remains a center of excellence for drug manufacturing and recently CAR T cell therapy has been manufactured (NEXCAR 19) with good treatment outcomes and at a fraction of the cost of similar therapy in other countries. The ability to increase the manufacturing of immune based therapies using innovative technologies will improve the outcomes for patients in India and worldwide.
Another recent study conducted in India showed that using the immunotherapy drug nivolumab at a markedly reduced dose compared to that used in Europe and the United States showed similar activity to the higher dose. This and similar studies by investigators in India will continue to increase the benefits for patients.
Cancer treatment often overlooks the impact on caregivers, who also require emotional support and networks throughout the treatment process. How can cancer research address these issues?
Cancer research must expand to include caregiver-specific metrics and conduct direct studies on their experiences. By utilising large-scale, longitudinal data collection and building on surveys from patient advocacy groups, researchers can gain comprehensive insights into caregiver challenges. These findings should inform the development of targeted support programs, such as counseling, financial planning assistance, and respite care within cancer treatment centers. Additionally, advocating for policy changes and training healthcare providers to recognise and address caregiver stress are essential steps.
At Memorial Sloan Kettering Cancer Center (MSK), we are dedicated to helping individuals navigate the emotional and social challenges of cancer and its treatments. We understand that each person’s experience with serious illness is unique. At our Counseling Center, psychiatrists, and psychologists tailor sessions to meet specific mental health needs, working with both individuals and families, and offering group sessions for shared experiences. Social workers play a crucial role in providing emotional support and guidance to patients, friends, families, and caregivers, with assignments on each patient floor of our hospital.
How might clinicians and cancer patients in India benefit from globally conducted research?
India’s diverse population and varied environmental factors contribute to a complex landscape for cancer incidence and treatment response. Global research studies encompassing diverse populations offer valuable insights into how genetic and environmental factors influence treatment effectiveness and safety. These studies cover a wide range of patient demographics, disease types, and genomic characteristics, ensuring findings are broadly applicable, including to Indian populations. By engaging with and adopting these findings, Indian clinicians can access cutting-edge treatment protocols tailored to local needs, ultimately improving patient outcomes.
Staying abreast of international research allows Indian clinicians to implement globally recognised best practices and innovative treatments, raising the standard of care and enhancing survival rates and quality of life for cancer patients. Collaboration with global counterparts fosters the exchange of knowledge, skills, and experiences, enriching the scientific community and contributing to the global understanding of cancer and its treatment.
What policy changes are necessary to facilitate access to cancer medicines under compassionate care use, particularly for rare cancers?
Firstly, recognising the longstanding issue, there’s a pressing need to establish specialised trials tailored for patients with rare cancers. These trials should focus on evaluating and repurposing existing drugs while concurrently developing new ones specifically targeting rare cancer types. Furthermore, supporting mechanisms such as initiatives like Cycle for Survival play a pivotal role. These initiatives not only raise awareness but also provide crucial funding for research and patient support programs, ultimately contributing to improved access to innovative treatments.
Additionally, policy adjustments to support decentralised trials are crucial. Enabling patients with rare cancers to participate in trials within their communities not only enhances accessibility but also ensures that patients receive treatment in familiar environments, potentially improving overall outcomes. Additionally, easing telehealth restrictions will expand access to care. Expanding telehealth services not only provides convenience to patients and their families, but could also circumvent certain financial barriers and offer patients more treatment options.
What emerging technologies, trends, and challenges in cancer research and treatment are you currently monitoring?
Utilisation of the immune system to combat cancer is an area of rapid advancement. We’re closely following developments in CAR T cell therapies, which involve modifying a patient’s own immune cells to recognise and attack cancer cells. Additionally, antibody drug conjugates represent another promising avenue, where antibodies are attached to drugs to precisely target cancer cells while minimising damage to healthy tissue. Furthermore, the exploration of tumor infiltrating lymphocytes shows potential for enhancing the body’s natural defense mechanisms against cancer.
Despite these exciting advancements, we recognise the ongoing challenges in healthcare delivery and access to care models. Ensuring that innovative treatments are accessible to all patients regardless of their geographic location or socioeconomic status remains a priority. We understand that effective cancer treatment must be available where patients can readily access it, and we are committed to addressing these disparities in care delivery. From our MSK center in Chennai, India, patients gain access to MSK’s globally renowned oncologists, cutting-edge research initiatives, comprehensive clinical trials, and educational programs. We are committed to bringing MSK’s world-class care closer to home for patients across India, ensuring that they receive the highest quality of treatment and support throughout their cancer journey.
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