Exploring Challenges and Advancements in Cancer Care

February 4th is World Cancer Day, an international day dedicated to raising awareness of cancer and encouraging its prevention, detection, and treatment. According to Michael Zinner, MD, numerous advancements have shaped the landscape of cancer care in recent years, including noteworthy shifts towards immunotherapy, targeted therapies, and personalized care.

Though many developments have transformed the field of oncology, it is crucial to stress the importance of raising awareness about the current era of cancer treatment when discussing World Cancer Day. According to Zinner, chief executive officer and executive medical director of Miami Cancer Institute, early detection plays a critical role in the treatment of cancer, but there are now repercussions of delayed screenings due to the COVID-19 pandemic.

Globally, disparities in cancer care also exist, particularly in regard to social determinants of health. At the Miami Cancer Institute, the Center for Equity in Cancer Research and Clinical Trials was designed to advocate for community engagement and collaborative efforts to enhance cancer awareness and support.

“We believe that cancer care and your ability to survive cancer should depend more on your genetic code than your zip code,” explained Zinner, in an interview with Targeted Oncology^TM.

In the interview, Zinner showed optimism about the future of cancer care, backed by his 45 years of experience, and provided an informative exploration of challenges, opportunities, and advancements in oncology.

Molecular structure of cancer cells under microscope, realistic macro indoor part of body: © annamaria – stock.adobe.com

Targeted Oncology: What challenges do oncologists face in providing optimal care for patients?

There are a host of challenges that we all face, but 1 coming out of the COVID-19 pandemic and the pandemic reportedly being over is that we are still dealing with some of the remnants of the pandemic, particularly around areas of workforce. Workforce has been a major issue for us and my colleagues all around the country. A lot of people left the healthcare workforce during the pandemic, and many did not return. That is particularly true in some of the highly specialized areas that we depend on for cancer care, including technical help, radiation therapists, dosimetrists, respiratory therapists, nurses, [physician assistants]yes add , nurse practitioners. We are facing that.

The second area, I would say, is more on the physician side, which is the avalanche of knowledge and technology. We have seen an explosive growth over the last couple of years in treatments and technology that we could not have predicted a long time ago. I’ll set this in perspective. So, 50 years ago, President Nixon declared war on cancer. At that time, the overall 5-year survival rate for cure was around 30% or 40% across the board. Now, it is 60% or 70% across the board. And why is that? Because we brought in all of this new technology, all of these new drugs, all of this immunotherapy explosion. For the practitioner, it is hard to listen and learn to stay up to date. It is a huge challenge to make sure that folks around the country, not just in cancer centers, and not just in teaching hospitals, but the practical people taking care of 85% of the cancer world, know what is going on in cancer.

Are there any specific opportunities or advancements that particularly excite you in the field?

I would say the transition away from the traditional 3 ways we treated cancer, which was surgery to cut it out, radiation to burn it out, and chemotherapy to poison it. We are now entering that new phase of immunotherapy, targeted immunotherapy, cellular therapy, and these targeted drugs that interfere with cellular mechanisms. All of those are the personalized cancer care that we have been seeking for decades. Now, we are on the threshold of applying it.

What is important to know about World Cancer Day? How important is the day in raising awareness about cancer both locally and across the globe?

The issue is awareness. Awareness of cancer and awareness by the population, the world, that we are in with a new era of cancer care. I would say, it is never a good time to be diagnosed with cancer, but there has never been a better time to be treated for cancer. That is what we need to make people aware of. There are ways of treating cancers we did not even imagine a few years ago. Early detection, to get out there, make yourself known, get the patient’s advocates in front of you, all of those things are critical.

What are some ways individuals and communities contribute to the objectives of World Cancer Day?

I always start by making sure that the message about early screening, particularly for those kinds of cancers that we know have positive effects for early screening, make a huge difference in terms of outcome. I’ll give an example. Here, we asked the question of what happened during the pandemic because we know that during the pandemic: a lot of patients delayed their screening, delayed their mammography, delayed their colonoscopy, delayed visiting their dermatologist or primary care physician. We looked at what the stage of cancers were that we saw pre-pandemic and what the stage of cancers we saw post-pandemic, during the pandemic, or just after the pandemic [were].

Lo and behold, what we found was that there was a stage migration where we saw more advanced cancers post-pandemic, because people had not done their screening. We just published that in a nationally peer-reviewed publication. Geoffrey Young, MD, PhD, FACS, who is our chief of head neck cancer surgery here, published it as the first author. We are very proud to say this tells us for sure, it is better to have this screening done. When we don’t have this screening done, we see more advanced cancers.

What are the major disparities in cancer care and access to treatment globally? How can these be addressed?

Huge question, and certainly an important social issue. The social determinants of care should not affect the care that we have with our patients. What am I talking about? I’m talking about transportation, patients working and then having to take time off for work, patients that need childcare, patients that need access to appropriate diets, all of those kinds of things are the social determinants of care. We decided to ask some questions around that. We started here at Miami Cancer Institute, the Center for Equity in Cancer Research and Clinical Trials to address just those questions. We believe that cancer care and your ability to survive cancer should depend more on “your genetic code than your zip code”. Unfortunately, that is what we see in those social determinants of care.

How can we break some of the stigmas surrounding various cancer types moving forward and increase awareness?

In those populations, what we have done is to engage navigators that are native speakers in whatever language or area that they come from, or come from the same community that those patients come from. That trust of having a navigator who comes from the same community who can relay that information to the patients who can bring them in, and either speak the language that they are speaking, or at least address the social determinants that they are there make a difference. We think that that will help in those social determinants of care.

How can communities and organizations work together to enhance cancer awareness and support?

I think that’s community involvement. The more we talk about how well we are doing, I think the community will respond positively. I would recommend that we have both private and public combinations, and that they work together in community efforts to [enhance awareness].

Is there anything at your institution that you do to kind of raise awareness or for World Cancer Day, specifically, or anything else that you want to share?

We talked about the social determinants, we talked about our interest in the community, and we are fortunate here in Miami Cancer Institute to have what we describe as some of the highest technology. Frankly, of anywhere in the country, we are the only place that we know of in the country that has every piece of radiation therapy equipment ever made under 1 roof, so that we can adapt the patient to whatever we need them to be, as opposed to just having them plugged into whatever device we have. We think having comprehensive care makes a difference in treating cancer and we hope to be able to provide that.

Cancer is my business, cancer care is my business, and I have been doing this for 45 years. I am more optimistic today than I have ever been in my career, and I want to make sure the public understands that.