In the battle against cancer, doctors are better-armed with treatment options than ever before. But the greatest change in cancer treatment is in the supportive services, such as anti-nausea drugs for chemotherapy patients.

There's no sure cure for cancer, so prevention and early detection are still the best ways to combat the often-deadly disease, according to oncologist Dr. Anna Beck.Beck and Dr. Jennifer Fischbach, a radiology oncologist, will be featured during today's Deseret News/Intermountain Health Care Health Hotline. The women will take calls and answer questions about cancer treatment, prevention and research.

One of the most exciting medical advances in fighting cancer is gene therapy, Beck said. It's not widely available because it only works for certain tumors that are caused by specific genetic defects.

If doctors can identify a missing protein, it can in some cases be reintroduced into the malignancy, stopping the progress of the disease. It doesn't undo damage already done and "it's very investigational," but it shows great promise.

For the therapy to work, a patient "must have a definable genetic mutation with a known defective protein that can be replaced." Where it's possible to use gene therapy, doctors have found they can often avoid the toxicity of chemotherapy in treatment, Beck said.

Immunotherapy is another growing field of cancer treatment and research. It involves stimulating a patient's own immune system to fight the disease or introducing antibodies directed specifically against the cancer. In that case, a toxic substance can be added that will bind directly to the cancer cells.

Such therapy is currently being used for some breast cancers and lymphomas.

"Those therapies are tolerated quite well," Beck said. "But the tumor has to express a unique protein antigen that normal tissue won't express."

New chemotherapy agents are also being developed that "approach a tumor from a completely different perspective," she said. Those agents can complement existing treatments.

Because of the improved supportive services for oncology patients, many of the devastating effects of past treatments have been overcome.

Chemotherapy used to involve sedation and overnight hospitalization because of the extreme nausea it caused. "Now you can get chemotherapy and go back to work," Beck said.

Other advances include a wide variety of hormones that can be used to stimulate bone marrow and reduce the risk of the "life-threatening infections" that were common in the past. "We can give more intense, effective doses," said Beck. That's why bone marrow transplants are now more successful, she said.

In fact, she said, there's a lot of good news in cancer treatment. In breast cancer, one of the most common forms of cancer in Utah, the death rate is declining. There are better therapies for melanoma and ovarian cancer, as well as pancreatic, lung, colon and breast cancers.

"It's not curative, but there are more bullets in our guns. We're improving chances, and the cure rates are creeping up."

One reason is earlier detection, "because there's better chance of a cure for an early-stage disease," she said.

And some prevention techniques are quite obvious, Beck added. Lung cancer is the most fatal of all cancers. "If we could make people stop smoking, that would be a big difference," Beck said.

Pharmaceutical companies are showing "renewed interest in performing clinical trials" of promising treatments. Beck credits changes President Clinton made with the Food and Drug Administration that made it easier to get approval. For example, she said, some drugs will not provide a cure but are considered effective because they can make a patient more comfortable.

Reality, however, has not changed. Some patients, despite treatment, are terminally ill. That's forcing doctors and other health providers, as well as the patients themselves, to make hard choices. A national oncology group encourages its member doctors to learn more about hospice care and communicate the information to patients.

In cases where treatments offer little hope of a cure or even significant improvement, patients need to weigh the side effects of treatment against the benefits and make decisions like whether they would be happier focusing on time at home with family and loved ones.

That's a hard choice, Beck acknowledges. "In my practice, I'm dealing with people who want to enjoy life. I have the nicest patients in the world, and it's very rewarding. Even helping someone accept their illness and die with dignity, in a pain-free setting, is very rewarding."



Call hotline today

The Deseret News/IHC Health Hotline will be available from 10 a.m. to noon today. The toll-free hotline number, 1-800-925-8177, can be called from anywhere in the Intermountain region, and all calls are confidential.