The Rapid Evolution of Cancer Care (and how to keep up)

Behind heart disease, cancer is the leading cause of death worldwide. There has been a ‘war on cancer’ since the 1970s and this has led to an exponential increase in research surrounding what causes cancer and how we should treat it.* 

In 1995 the National Comprehensive Cancer Network (NCCN) was developed in the United States. The NCCN puts out guidelines on clinical practice for the majority of cancers. 

When the guidelines were initially released in 1996, they were roughly 26 pages long.* 

As of 2019, the guidelines were 198 pages long, increasing at a rate of 7.5 pages each year. 

The guidelines also include ‘decision paths’ which are like graphs to guide decision making based on cancer type, genetics, grading, and staging. At first, there were 30 decision paths which increased to 111 in 2019.* 

Experts anticipate the length of these guidelines to increase to 355 pages by 2025 – with over 1,954 references cited for each guideline.* 

Developments in how cancer is treated changes faster than almost any other speciality thanks to high quality research and drug discovery. Today we’re going to cover some of the evolution of cancer treatment and discovery to highlight how rapid knowledge around cancer care changes. We’re also going to share some tips on how to keep up with these changes. 

Chemotherapy Advancements

Chemotherapy has had an interesting journey, with many treatments being discovered by accident. 

Cancer treatments involving medications started evolving in the 1940s including antimetabolites and mustard gas thanks to World War II. In 1953, methotrexate cured the first solid tumor.* 

Back then, chemotherapy wasn’t precise or targeted. Healthy cells were targeted the same as cancer cells. 

The evolution of medical oncology is largely guided by making treatments more targeted and personalized. This has been made possible with breakthroughs in genetics and hormonal testing. 

The HER2 gene, a gene that is overexpressed in nearly 25% of breast cancer patients, was discovered in 1984. Patients who are HER2 positive are more likely to have more aggressive forms of breast cancer. * 

BRCA1 and BRCA2 genes were discovered in 1994 and 1995 and it was found that mutations in these genes greatly increased the chance of several different cancers in both men and women, including breast and ovarian cancer. * 

Drugs have been developed to target HER2 receptors and aggressive therapy is often chosen for those with BRCA mutations. 

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In 2017 oncologists began doing truly personalized cancer treatments with chimeric antigen receptor T-cell therapy AKA CAR-T therapy. CAR-T therapy involves taking the patient's own T cells and genetically modifying them to fight rare types of leukemia and lymphoma. * 

In less than 80 years, chemotherapy evolved from war-time mustard gas to modifying individual patient genetics to fight cancer. 

Cancer Surgery Progress

Physicians have been surgically removing tumors for centuries. The radical mastectomy was developed in the 1700s, back when physicians thought local extraction was all you needed to do to cure cancer. They weren't aware of the concept of metastasis and how cancer can spread through the lymph system. * 

Radical mastectomies were used for over a century until clinical trials showed less invasive surgery was equally as effective. The modified radical mastectomy was less invasive and disfiguring and later, lumpectomies became standard for many breast cancers.

Now most breast cancer patients undergo lumpectomy followed by surgery according to the American Cancer Society. * 

The same progress was made when it came to removing bones and soft tissue for cancer rather than total amputation and reducing the need for colostomies for rectal cancer surgery. * 

In addition to reducing the extent of surgical removal, there was a reduction in exploratory surgeries. This was thanks to the development of imaging technology to better identify the extent of tumor spread prior to surgery. * 

Radiation Therapy

Radiation therapy was first used in an attempt to treat cancer  in 1903. By 1945, radiation therapy had cured patients of lymphoma.* 

In the 1970s, clinicians started implanting radioactive seeds to treat hard to treat cancers and radiation allows for women to have modified mastectomies.* 

Radiation therapy combined with chemotherapy became the next best option in the 1980s when patients could not have surgery to remove cancers, and combination therapies were proven to improve outcomes for many different types of cancer.*

In the 1990s clinicians started using radiation therapy for a number of treatments for lung cancer patients. Radiation to the lung twice daily improved outcomes for small cell lung cancer and prophylactic cranial radiation was shown to reduce the risk of small cell spreading to the brain.* 

Today, 50% of patients diagnosed with cancer will receive some type of radiation therapy as a part of their treatment.*

A New Way to Keep Up 

Although there have been numerous breakthroughs when it comes to radiation therapy, a 2022 report shows that less than 10% of radiation therapy guidelines have a category 1 rating when it comes to consensus and evidence.* 

This means the majority of guidelines could use additional research and validation to further support the recommendations. So while there have been amazing advances – there is still work to be done. 

Cancer treatment guidelines are growing at a rate difficult to keep track of and experts anticipate the growth will continue to speed up. While more guidelines sound good, it creates a gap between knowledge and application if clinicians can’t keep up.

The Journal of the American Medical Association published an article in 2020 voicing concerns over the rapid changes in oncology guidelines. The authors state the volume of new data and information that needs to be shared for optimal patient care will soon be overwhelming for clinicians.* 

They recommend new ways of information sharing should be developed – including guideline stratification and the use of artificial intelligence (AI) to help support decision making.*  

In addition to making guidelines more streamlined, research articles need to be streamlined. At Juisci, we’re using AI tools to bring you the most important oncology articles straight to your phone.

We bring you the research other clinicians find valuable, useful, and impactful. Plus, we create engaging content so you can stay up to speed without pouring over abstracts all day. 

You can customize your Juisci app to send you only what you need to be updated on and you can engage with other clinicians through our Juisci community. You can feel confident you’re caught up on the latest guidelines and medical journals with just a couple minutes a day. 

If you haven’t already, download the Juisci app and start catching up today.