The Cure

According to WHO the likelihood of death from a non-communicable disease is much greater than dying from cancer. In Italy, more than a quarter of people living with a cancer diagnosis have similar death rates to the general population. Moreover, nearly three quarters will not die as a result of their cancer. And, as with life expectancy, in general, Italian women fare better than Italian men. Overall, the cure prevalence, in this recent study published in the Annals of Oncology, was 67% for men and 77% for women.

Centuries ago, cure was easy to define. It was the eradication of an invader in the body: an evil spirit, an ill humour, a bacteria. When the invader was defeated, cure followed.

What these Italian data suggest is that cancer can be out-lived but not for all people though and not for all types of cancer. The “good news” is that patients who have some cancers can live long enough to die from other causes. And some cancers can even be cured – thyroid and testicular cancers, in younger patients, have a greater than 90% cure rate; liver and pancreatic cancers have a less than 10% cure rate and others cancers hover in between.

So, what is a cure?

Centuries ago, cure was easy to define. It was the eradication of an invader in the body: an evil spirit, an ill humour, a bacteria. When the invader was defeated, cure followed.

Towards the middle of last century “curative” medicine had its greatest successes, at both an individual and a community level. Penicillin and the subsequent antibiotic army cured most bacterial diseases. Vaccination and public health practices cured the world of toxic viruses such as smallpox and polio.

Despite subsequent decades of valiant attempts, eg to cure Ebola and HIV/AIDS no new cures have emerged (pity the medical profession. We promised cure and have consistently failed to deliver). This is because last century treating and controlling infectious or communicable disease was superseded by the need to address non-communicable diseases such as arthritis and hypertension; health problems, where there is no cure, and death are often due to sequelae or other causes.

Public campaigns and clinical vigilance help patients maintain a healthy blood pressure, but cannot cure the cardiovascular damage that may accompany the condition and cause death. For example, a dozen or so of the 300 odd joints in a body can be replaced but never enough to cure arthritis.

So, if cure is no longer defined by eradication of both infectious and non-infectious diseases, what do these data from WHO and Italy signify for health care? Could it be that cure as we know it, is no longer the goal of treatment?

Treatment that successfully prolongs life or prevents death will replace cure as the healthiest outcome. We are already recognizing this phenomenon in cardiovascular disease. Rather than labelling hypertension as an incurable health problem, the successful management of it is the goal of treatment not cure. The Italians have translated this concept to the world of cancer suggesting curing cancer is when something else kills you.

We have already killed disease, now we can kill cure.

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