Cancer treatments are advancing, but not fast enough for yesterday's patients 

• Michael Külbel

The stage at Skyview High School was scuffed, worn and feeling very small. It was December 2017, and the school's student government had promised everyone that if they met a certain donation goal during a charity event, each boy in the leadership group would either have his head shaved or legs waxed during an assembly. I had chosen the latter option.

After spreading wax all over my left leg, a fellow student waited several minutes to finish the job, giving the wax too much time to cool and harden. She pulled and pulled to no avail until I held up my arm to stop her. I was choking back tears.

I quickly learned the bathroom's soap was no match for the sticky substance, so I drove home and continued the effort with a razor and bottle of industrial strength adhesive remover. I was a bloody mess when my father called my siblings and me into the living room.

"Mom is having a hard time letting go," he said. "But I think if you guys told her 'Goodbye,' it would help."

All of us had known this day was coming. I'd tried to convince myself it would never arrive, but it did, on that day, forever enmeshing the most painful memory of my life with the fun-loving antics of my high school class.

My mom was asleep when I walked in. There had always been one non-negotiable rule for me whenever I returned home at night: No matter what time it was, I had to wake her up and tell her I was OK.

This time was different. I knew it didn't matter how loud I said her name or shook her shoulder—she was not going to stir. Still, I knew I could tell her I was all right. I'd been told she was likely aware of what was happening around her.

I wish I would've leaned in close, but I didn't. There was a dreadful sort of comfort in the few feet I kept between us. "I love you," I told her. "I'll be OK. You can go if you need to, and we'll be fine."

I was lying.

We buried my mom five days before my 18th birthday. Though she'd been suffering for weeks, the pain didn't feel like a band-aid getting ripped off—it felt like someone yanking at cooled wax, unable to pry it loose. I have yet to find anything that can provide true relief, and since her passing, I've suffered with anxiety, depression, suicidal thoughts and obsessive-compulsive disorder. I never gave myself time to slow down and heal, so I never did.

In my grief, I've wondered if some small decision might have changed the trajectory of the disease that took my mom's life. What if she hadn't loved tanning? What if she'd grown up somewhere different? What if her relapse had been caught a little bit earlier?

And what if we could have shifted the world's timeline, just a bit—speeding up the development of cancer diagnostics and treatments?

In the 20 years before my mother died, the rate of cancer deaths in the United States fell by roughly 1% each year. But in the years to come, many physicians and researchers believe the mortality rate will fall faster and faster, and that even late-stage cancer diagnoses won't be the death sentences they are today, or were yesterday.

Perhaps I was born too early for medicine to save my mom—but just in time to see how it might have.

• Courtesy Photo
• Author Brock Marchant, right, in his teen years, with his mother and brother at a scouting event.

Turning Points
The term "cancer," in a broad sense, is misleading. That's what I learned from Nathan Price, who received his bachelor's degree in chemical engineering from Brigham Young University before going on to earn a master's degree and doctorate in bioengineering. He's now the chief science officer at Thorne HealthTech, a company seeking new treatments to myriad diseases.

"'Cancers' should basically always be used in the plural," he told me. "Cancer is not a single thing. It's a million things."

Price recently co-authored a book titled The Age of Scientific Wellness about how developing technology will transform healthcare, making many chronic diseases a thing of the past. And treatment for cancers, he wrote in the book's ninth chapter, is at a "turning point," thanks to early detection, therapies that bolster individuals' immune systems and vaccinations.

"We're starting to shift from this notion that we don't know what to do about cancers to we know what to do for some cancers, and it works really well," he told me. "We have to now solve the problem that [treatment]is too expensive, and we've got to get costs down so we can apply it broadly, and we've got to make it applicable to more cancers."

Price recognizes that not everyone shares his optimism. But not everyone has shared his personal experiences, either.

About midway into our conversation, Price started to mention his younger sister who had been diagnosed with stage-4 breast cancer at just 23 years old. Horrified that someone so close to my own age had been diagnosed with a disease similar to what killed my mother, I braced to apologize for his loss.

But my words didn't quite get out before I realized he wasn't talking about his sister in the past tense.

"She seems to have survived it ..." he started saying.

My mind stalled for a moment. I've conditioned myself to hear the words "diagnosed," "stage 4" and "breast cancer" and assumed the next word would be "died." Though I knew no individuals' cancers were the same, I quietly wondered how his sister's cancer and its treatment were different from my mom's.

As we spoke more, it became clear that their treatment was similar in several ways. For instance, my mom's life likely would have been cut even shorter without Herceptin, an immunotherapy drug she was given in conjunction with her chemotherapy treatments. I recognized the name of the treatment as soon as Price said it, though it wasn't until after our conversation that I confirmed it had been a relatively consistent part of my mom's treatment plan.

Because her breast cancer was HER2-positive—meaning it contained extra copies of the gene that makes the HER2 protein—Herceptin was able to track that specific code and target the mutated cells. Still, as Price was sure to include, early detection continues to be a critical factor in the treatability of breast cancers.

"Once [the cancer] has metastasized," Price said, "it's really hard to put the genie back in the bottle."

I'd once taken refuge in similar statements made by doctors. When I was 9, and my mom was first diagnosed with stage-2 cancer, I was constantly reassured by doctors and my parents that it had been caught early and was treatable. She would live, and—while no former cancer patient is ever entirely out of the woods—she would likely die of something entirely unrelated, perhaps something like a heart attack after seeing her favorite child make financially inadvisable career choices.

But when I was 12, about a year after her supposedly final round of chemo, my family learned early detection isn't always a panacea. Though there had been no detectable cancers at the end of her treatment, it returned, and the genie was not only out of the bottle, it was in her bones, brain and liver.

Toward the end of our conversation, I asked Price where he thought breast cancers would be in 10 years, and then in 20 years.

"I do think the fatality is going to go down quite a lot. I'd like to see it at least cut in half in the decade," Price said. "In 20 years, I think maybe we've really reduced cancers significantly."

I suspected he was reticent to sound too overconfident while speaking on the record with a journalist. The internet has an unforgiving memory, and Price is still relatively young in his career.

I didn't push him to speak more definitively, but with the new horizons of treatment options for various cancers fresh on my mind, I asked how much faster he thought things could progress if research was hypothetically unregulated and resources were hypothetically unlimited.

"We would be able to progress much faster," Price said. "We'd find much quicker remedies." But, we would also kill a lot of cancer patients in clinical trials.

Price told me of an experience he had interviewing for grad school when he met a man who had learned how to cure diabetes in a mouse. "I was like, 'Wow, that's amazing,'" he recalled. "[The man's] immediate response was, 'Everyone can cure diabetes in a mouse.'"

Mice can be studied—sacrificed, even—for the sake of research and knowledge. Understandably, we are much more careful experimenting with new drugs on people.

• Courtesy Photo
• Brock Marchant, second from right, with his father and siblings at his mother’s funeral.

"As a society, we've basically made the bargain that we're going to live with slower uptake in medicine to try to avoid those really explicit harms coming from the overspeed in the medical field," Price said. "Those get to be thorny issues."

He mentioned the creation of COVID-19 vaccinations—which, according to one recent study, prevented more than 18.5 million U.S. hospitalizations and 3.2 million deaths, and saved the country $1.15 trillion—as a recent example of how quickly medical solutions can be presented to the public when there is a dire and immediate need. "That was one where the negative of not advancing something quickly was very obviously seen and taken into account," Price said.

Unlike COVID, cancers take their victims over time, spread out over periods of years, and thus the disease is perceived as less of an immediate threat to large numbers of human lives than a fast-moving pandemic, making cost-benefit analysis of quickly moving trials much more complicated.

And so, we continue on slow and steady, and consider 20 years "fast" and 10 years "immediate" in terms of developing effective treatments.

But Price still seemed to think that, through one field of study or another, monumental advancements in the treatment of late-stage cancers were coming soon.

Shoulda, Woulda Cured-ya
Irving Weissman, M.D., had resigned as director of Stanford University's Institute of Stem Cell Biology and Regenerative Medicine about a year before I spoke to him. When I learned why, I nearly spit out my drink.

Weissman had left his appointment to further explore results from an experiment he conducted more than 20 years earlier that pointed to a possible—and, he believed, even likely—cure for cancer.

According to a Stanford article describing his formative years, Weissman's first dive into the world of scientific research was under the supervision of Ernst Eichwald, M.D., a University of Utah alumnus and professor who was a trailblazer in transplant research. According to a quote from Weissman in the Stanford article, Eichwald was also a hard-to-understand scientist who, after being recruited from the U to Montana Deaconess Hospital, was willing to let high schoolers help him in his research lab.

It was the lessons he learned from Eichwald that helped Weissman develop research skills of his own, he said. And though Weissman said he was never in the top of his class during his time as a student, he graduated from Stanford's medical school in 1965. In the late '90s, he took part in a pilot-experiment with results that he found to be extremely promising.

"We had isolated blood-forming stem cells, and we showed it depletes any cancer, including breast cancer, on the order of 250,000-fold," he said. "So if there were breast cancer cells in the mobilized blood, we could purify them away from almost all or all cancer cells."

When patients were receiving intense chemotherapy treatment, Price explained, they could also be given those blood-forming stem cells rather than unfiltered, cancerous blood.

Weissman and his colleagues had begun an experiment to test the efficacy of the method but, around the same time, a few key principles in the treatment of metastatic breast cancers changed, and oncologists working with metastatic breast cancer patients began looking to improve the quality of life for patients rather than curing them completely. Concurrently, the company providing funding for Weissman's experiment was purchased by Novartis, a giant in the pharmaceutical sector, which then cut funding to the experiment about three years after it began.

Weissman said he again attempted and failed to secure funding to conduct the experiment. Then, in 2012, the results of the initial study were published.

Out of the women who were treated with the usual methods, half had died within two years. And after 10 years, all were either dead or in active, ongoing cancer treatment.

But the group of women who were treated with blood-forming stem cells saw dramatically different results. "Half of them were dead in 10 years instead of two," Weissman said. "One-third are alive [today] without disease."

Weissman said that he's currently meeting with interested parties to replicate the experiment and make the treatment more affordable.

"By the end of the year, if we're lucky, we'll be at the FDA to go ahead and do it again," he said.

I asked him where he thinks we would be had he continued to receive funding for the experiment in its initial attempt. Weissman didn't even pause to consider the question, saying it could have radically shifted the trajectory of cancer treatments.

"We cured a third," he said, "and the rest were slower to get their cancer back."

I wanted to push the matter further. Could my mom still be alive if the funding, resources and timing had all fallen into place for Weissman's vein of research?

Instead, I held my tongue. I'm not sure I was ready for the answer I expected he would have given.

Buying Time
I didn't think Saundra Buys, M.D., would even answer my email. After all, it had been five years since she treated my mom for cancers, and I knew that Buys, the University of Utah's oncology division chief, was extraordinarily busy. To my surprise, she found time to talk within the week.

Not only did Buys remember me and my mom, she also asked about my family, how things had gone since my dad remarried and how everyone was doing in general. It was this personability and care that had made my mom so comfortable turning to her for treatment.

After catching up, we got into the reason for the call—I asked her if there had been any developments in the treatment of breast cancers since my mom died.

No, Buys said, not really.

"For most cancers that we have successful treatments for, there's been a moment where things just dramatically changed," Buys said. "For example in the '60s, the development of chemotherapy for Hodgkin's disease. It turned this from always fatal into a generally curable disease."

Buys identified similar advances in the treatment of breast cancers: the identification of hormonal therapy; discovering that administering chemotherapy to patients with early-stage disease reduced the chance of later reappearance; the creation of HER2+ targeting drugs; and the utilization of genomic profiling in determining the necessary intensity of treatment.

But all of that had happened before my mom's diagnosis and death. The advancements that have come along since then, Buys said, were "just a little fine-tuning."

"None of them are earth-shaking, they're all just kind of increasing, incrementally, the likelihood that somebody will either not have metastatic cancer or will live longer if they do," she said.

• Courtesy Photo
• “We still wouldn’t have anything that would cure [stage-4 breast] cancer. But we have things that could have bought some more time.”—Saundra Buys, M.D.

After the cancer's return, Buys said, there were a few minor changes that might have been made to my mother's treatment, but nothing radical. Perhaps she would have prescribed an accompanying drug with Herceptin, and she likely would have used a different kind of chemotherapy to treat the brain.

"We would've had a few more treatment options. We still wouldn't have anything that would cure this cancer," she said. "But we have things that could have bought some more time."

Those words stayed with me for a long time after our conversation. While "some more time" for just one patient might mean little at a societal level, I couldn't help but think about how much that time would've meant to me and my family.

Another Christmas? Another birthday? Maybe my sister's wedding? Maybe mine? "Some more time" means a lot when somebody you love is dead.

Looking toward the future, Buys seems to set her expectations for a lot more disappointments than miracles. And who can blame her? When my mom first walked into her office, Buys made her feel more important than just another patient and more significant than a medical chart or a diagnosis. She made my mom her friend.

But in a span of 10 years, that friend moved from a walker to a wheelchair to a deathbed. How many friends can a doctor lose before becoming skeptical?

"I think there are really great things coming but, Brock, I've been hearing the same thing for the 40 years I've been in oncology, so I guess I'm a little less rosy about it. I think my best guess is we're going to be making incremental benefits and then, in some diseases, we'll make gigantic benefits," she said. "I don't think there's likely to be an overall, 'Wow, this is the answer to all cancer.'"

Later on, I wondered how she might have responded if we cut out the obvious fact that development happens incrementally and just spoke in terms of decades of research development. What will the prospects be for someone diagnosed with my mother's kind of cancers 10 years from now? What about 20 years from now?

Alas, I didn't ask. And I suppose I could have called her to follow up with those questions, but I didn't. I tried to convince myself it wasn't worth it to bother her again. Deep down, I wonder if I was again scared of what someone familiar with the field might say.

What If
My mom started a blog after her second diagnosis. It's still online—just an internet search away—and on the days I miss her the most, I find myself reading her words.

Her final entry was titled "My Bucket List," and detailed an experience she had attending a meeting with a typical get-to-know-each-other game. She recalls being asked about hobbies, favorite foods and items on her "bucket list," the things she'd like to do before she died.

"I hadn't thought about it too much. My first reaction was I want to go to Hawaii with my family," she wrote, mentioning a recent trip she had taken with her mother and sister. "I knew that I wanted to see [my husband] Paul's and my children's faces as they watched the beautiful sunsets while playing in the ocean."

My mother continued to share her hopes for the future beyond a tropical vacation with her family.

"I am thankful for that gift I've been given," my mom wrote. "I want to watch them when their eyes sparkle when all their dreams come true. I am going to keep the hope of seeing their faces as the sun sets across the sparkling blue ocean and waves wash in with the tide."

I can't change the past, no more than I can speed up the future. But I suspect strongly, now, that there have been points in time in which we could have made greater headway against the cancer that killed my mom and that we are potentially on the cusp of more such moments in the fight to help more people survive cancers.

We were so close to making it to that beach.

Brock Marchant hails from Cache County and studied journalism at Utah State University. He works as a staff writer for The Park Record and formerly wrote for The Herald Journal.

If you or someone you know is struggling with suicidal thoughts or mental health matters, call the 988 Suicide and Crisis Lifeline.

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