Dr. Bruce Feinberg’s take on Cancer: Emperor of all maladies

CONTRIBUTOR

Bruce Feinberg, DO

Vice President
Chief Medical Officer
Cardinal Health Specialty Solutions

P BS recently aired Cancer: The Emperor of All Maladies a “biography” of cancer, covering everything from its earliest appearances to modern-day efforts to cure, control and conquer the disease. Based on the Pulitzer-prize winning book, the film highlights some of the pioneers in cancer research as well as today’s most promising scientific advances. We asked our own pioneer in oncology research, Bruce Feinberg, DO, for his perspective on the film and his thoughts on how Cardinal Health is contributing to the future of oncology research. Dr. Feinberg is vice president and chief medical officer for Cardinal Health Specialty Solutions and has more than 25 years of experience in cancer care, the majority as a community oncologist.

Q: The film Cancer: The Emperor of All Maladies interweaves personal stories of cancer patients with a historical narrative on the evolution of cancer treatment. Why is a historical perspective helpful in understanding how cancer is diagnosed and treated today?

A: Whereas much of medicine’s history dates back thousands of years to ancient Egypt and Greece, oncology, the study of cancer, didn’t have its birth until the latter half of the 20th century. The field is still in its infancy and, for the most part, we have been crawling but not yet able to walk. It is only with this perspective that the progress or lack thereof can be viewed rationally.

Q: Your former practice and some of your former colleagues were featured in the film. Tell us about that part of the film and the research your practice was involved in.

A: The second episode focused on the crisis in breast cancer that emerged in the 1990s. The slow pace of clinical research was being confronted by the urgency and desperation of breast cancer patients in need of solutions. Physicians were in the center of the controversy and were conflicted by what was in their hearts and minds. To be aware of well conducted Phase II research that offered women hope of survival but denying them that hopeful treatment for the 5-7 years needed to complete Phase III research was agonizing for both physicians and their patients. Larger practices, like mine, made the difficult choice to expand the research outside academic centers into the community and to a larger patient base where it had not traditionally been performed. Among those research trials was one that studied high dose chemotherapy with stem cell transplant. Because the study was controversial, it resulted in a report on the late night news show Nightline for which I and my partner were interviewed. Apparently b-roll from that Nightline episode was archived, found by the documentarians and selected for inclusion in the PBS film. On my viewing of that second night, I saw three seconds of that b-roll with my partner and two nurses in our transplant center back in 1992.

Q: The film highlights many of the breakthrough areas of oncology research that are showing promise, such as genomics and immunotherapy. As you consider these advances, what gives you the most optimism for the future?

A: I have been a student of the field since I entered my fellowship thirty years ago. It is hard not to temper enthusiasm with so many prior disappointments, but I truly believe that this time is different. I don’t believe we will ever eradicate cancer as it is a disease of aging cells. As we understand and conquer avoidable deaths through vaccines, seatbelts, cessation of tobacco use and medicine, our life spans will increase but we will remain mortal and cancer will continue to be a threat. I do believe that our understanding of the science—genomics and immunotherapy—that underpins cancer will change our reality such that cancer will be universally cured in children, avoidable through healthy lifestyle in middle age, and remain a cause of death in the aged but without suffering.

Q: In what ways is Cardinal Health contributing to the future of oncology care?

A: The changes I describe in the prior paragraph will happen slowly over time. All of the stakeholders: patients, physicians, pharmaceutical manufacturers and payers will have a role to play in that transformation. Cardinal Health stands at the center of that stakeholder engagement. Today, Cardinal Health is playing an active role in helping the healthcare industry better understand real-world oncology care through health economics and outcomes research. By studying real-world evidence, we can identify the true value of care and provide insights that may eventually lead to better outcomes.