I always wonder whether we have our goals of care prioritized properly when we are caring for our cancer patients. I have many reasons to believe that we may not be doing enough to save every life that can be saved, starting with the work setting being named erroneously as a “Healthcare System,” when it should be called a “Sick Care System”; even caring for the sick has much room for improvement with more than 100,000 annual deaths from medical errors and double that number of preventable deaths from thromboembolic diseases, in the United States alone. This casts a shadow of doubt about the preparedness of this system to be an appropriate infrastructure for the culture of cure.

However, when focusing on cancer care, there are additional challenges to spreading the culture of cure. Prevailing pessimism among the public and many health care professionals, including some oncologists, presents the first line of challenges, which get further compounded by inappropriate processes, infrastructures, and access to care.

There is a need to revolutionize the way cancer education is conducted with more focus on how to identify curable cases and manage them properly and how to manage preventable causes of death. We need to simplify our education approach to help physicians distinguish between the “nice to know” from the “must know.”

The philosophy of cure should be crystallized, delineated, and disseminated widely. Having cure-oriented management guidelines is critical. It does not make sense to categorize therapy that prolongs survival for a few days as level I evidence while treatment that cures 90% of patients also carries level I evidence. We call both “standard of care” and we judge practitioners by their adherence to this standard. Why do we focus on the median survival of patients when not much attention is paid to the tail of the curve?

Are our multidisciplinary tumor boards optimistic enough to look for curable cases among the borderline cases? When in doubt, do we always give patients the benefit of the doubt?

I do not think anyone has a magic stick, but unless we put this issue for consideration and serious debate and discussion, we will not have the substantial changes necessary to save more lives; we will continue to drown in the flood of information that is “nice to know” but will not provide an iota of help to our patients.

I would like to hear feedback about how to establish and promulgate the culture of cure starting with the definition of cure, which I intentionally avoided discussing, to the components of this culture and the steps to instill it in our practitioners and our systems. How can we demystify oncology education to make it more effective in saving more lives? Why are internal medicine residents trained to manage MI and do cardiopulmonary resuscitation and other very complex tasks, yet get paralyzed and call for immediate oncology consult when they see a mass that “looks like”  cancer or  “may be” cancerous?

Just wondering!