The Culture of Cure—Part 2: What Is “Cure”?

The Culture of Cure—Part 2: What Is “Cure”?

Abdul Rahman Jazieh, MD, MPH

@jaziehoncology
Nov 22, 2011

In my first blog post on this topic, I discussed the challenges of creating a culture of cure. It seems that the first hurdle we have to overcome before we talk further about the culture of cure is to define “CURE.” It is quite intriguing how both simple and complex this word is. Everyone knows what it means, yet it is difficult to express in words and more difficult to explain in cancer care. I have a very good colleague, a radiation oncologist, who assertively stated that: “There is nothing called a ‘cure’ in our business. We can control cancer, make it disappear, but we cannot “cure” cancer patients.”

Some of us may shrug off this statement quickly claiming it can be easily proven wrong by the millions of patients who survived cancer. But wait a second—is survival the same as cure? We call, or label, patients who overcome the disease for a period of time “cancer survivors,” a description attached to the disease itself. Isn’t it true that cancer patients will not go back to their baseline again? They will never be their usual selves again; at least emotionally and psychologically, and sometimes physically too. Physicians may equate cure as crossing the magic five-year-line free of cancer. On the other hand, some patients may celebrate the news of complete remission as cure. Would you consider a patient who survived 10 years cancer-free, but was paralyzed by a cord compression at diagnosis, a cured person?

Does the definition of “cure” require a state of mind of feeling well combined with good physical health?

If we accepted the definition of “cure” as “restoration of health; recovery from disease,” then what would be the requirements to attain cure in cancer care?

The fundamental prerequisite is to eradicate the disease without untoward impact on patients’ health, allowing them to continue their normal life. In order to achieve that, we should be able to accurately diagnose the disease and properly characterize it, profile it, stage it etc. . . . then determine the best approach to eliminate it with the least possible harm to the patient. Terminating the enemy with no collateral damage, if we used the cancer war analogy.

It may sound like a naively oversimplified concept. Well! That is the whole purpose of this commentary—to simplify the thought process as we strive for the best yield. Lately, oncology care has become complicated even to specialists, in addition to oncology care being taboo for non-oncologists.

What will be the tools and resources required to accurately diagnose the disease and characterize it and then decide on eliminating it?

Enhancing the culture of cure requires proper education for  public and health care professionals, functioning multidisciplinary teams, adhering to a structured management approach, and implementing patient-centered, cure-oriented evidence-based medicine, and other quality improvement and safety processes.

I will be discussing some of these issues in future commentaries, but before I close, I would like to thank colleagues who gave me feedback and those who debated with me the definition of “cure.”

 

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Comments

Nagwa Abdel Rahman Ibrahim, PharmD, PhD

Nov, 28 2011 1:49 PM

Thanks for this interesting and vital topic. Definition of cure is considered crucial mainly to health care professionals, decision makers, patients and their families. Generally, the term cure is defined as the total eradication of the disease. However, term cure in cancer research was taken to mean an overall 5 year survival rate.  If a patient asks what is the percentage of cure after starting treatment? Mostly, the answer will be as 5 or more remission rate. So, the longer the remission time lasts, the greater the possibility that the cancer has been cured, keeping in mind the cases of cancer recurrence many years after remission starts.
Therefore, in this era I think we might consider cancer as a chronic disease that needs long term treatment as well as follow up considering patients quality of life. So, I agree with you that proper education at all levels and aspects is essential.


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