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Lessons Learned from Mother Nature
Editorial Edward Chu, MD Chief, Section of Medical Oncology Professor of Medicine and Pharmacology Associate Director of Clinical Research, Yale Cancer Center Yale University School of Medicine New Haven, CT
Lessons Learned from Mother Nature Normally in this commentary section, I review and reflect on a specific subject matter presented in the journal that has particular clinical and therapeutic relevance to the treatment of colorectal cancer. However, given the devastating aftermath of hurricanes Katrina, Rita, and most recently Wilma, this is an opportune time to reflect on the lessons learned from these natural disasters. Perhaps the most obvious lesson is that the normal way of life we, here in the United States, cherish so much and take so much for granted can be changed and disrupted in an instant. In the case of Katrina and the subsequent hurricanes, it was Mother Nature imposing her will on the people living along the Gulf Coast and in Florida without any consideration to sex, ethnicity, age, or socioeconomic status. In much the same way, diseases such as cancer can dramatically impact one’s entire life. Natural disasters and diseases such as cancer are certainly the great equalizers, as they affect men and women, young and old, rich and poor in exactly the same manner without discrimination and without warning. For me, then, the message is quite loud and clear: material things are, in essence, nonessential and immaterial in the grand scheme of things and that the most precious elements of life are one’s family, loved ones, and close friends. In addition, heart and soul, the commitment and dedication to family, friends, and community service are special core values and are the critical elements that will revive the areas hardest hit by Mother Nature and support the arduous task of rebuilding communities and the lives within. Another painful lesson learned in the aftermath of Katrina is that much of the destruction could have been avoided had the local, state, and federal governments heeded the long-held warnings that New Orleans was indeed in danger of massive flooding should it take a direct hit from a massive hurricane and that complete reconstruction of the coastline and levee system was required to prevent such devastation. Moreover, required evacuation, as was done with hurricane Rita, would no doubt have saved countless lives. Although there is no dispute and disagreement now as to what should have been done, such pronouncements
232 • Clinical Colorectal Cancer November 2005
are easy to make in hindsight. Where were the visionaries who could have and should have made a difference in preventing and/or avoiding these horrific disasters? How can the lessons learned from Katrina and her sister hurricanes help in our fight against colorectal cancer? First, there is no question that the single best way to treat colorectal cancer is to prevent its occurrence and/or detect it at the earliest stages. In this regard, we as physicians need to be the voice of reason and vision and continue to educate the public with the information that colorectal cancer screening and early detection remains the best way for us to cure this disease. When caught at an early stage, this disease can be cured in as many as 90% of patients. Unfortunately, very little in the way of resources from the federal and private sectors has been focused on developing a comprehensive nationwide plan for effective screening, with virtually the lion’s share of the key financial resources used for research and development of new treatment strategies. Yes, it is true that tremendous progress has been made in the treatment of advanced disease in just the past 5-7 years with the introduction of novel cytotoxic chemotherapy and biologic agents; however, even though significant advances have been made in improving the 2-year survival of patients, this progress remains incremental at best, and we have yet to impact the actual cure rate of patients with advanced and metastatic disease. One approach that has been used to improve patient curability is to advance the optimal combination regimens identified in the metastatic disease setting into the neoadjuvant and adjuvant settings so as to prevent the recurrence of disease. As with Katrina and her aftermath, a broad vision of where we are heading with respect to developing truly effective detection, prevention, and treatment strategies is desperately needed if we are to really impact the eventual cure of patients with colorectal cancer.
Edward Chu, MD Editor-in-Chief
Lessons Learned from Mother Nature Normally in this commentary section, I review and reflect on a specific subject matter presented in the journal that has particular clinical and therapeutic relevance to the treatment of colorectal cancer. However, given the devastating aftermath of hurricanes Katrina, Rita, and most recently Wilma, this is an opportune time to reflect on the lessons learned from these natural disasters. Perhaps the most obvious lesson is that the normal way of life we, here in the United States, cherish so much and take so much for granted can be changed and disrupted in an instant. In the case of Katrina and the subsequent hurricanes, it was Mother Nature imposing her will on the people living along the Gulf Coast and in Florida without any consideration to sex, ethnicity, age, or socioeconomic status. In much the same way, diseases such as cancer can dramatically impact one’s entire life. Natural disasters and diseases such as cancer are certainly the great equalizers, as they affect men and women, young and old, rich and poor in exactly the same manner without discrimination and without warning. For me, then, the message is quite loud and clear: material things are, in essence, nonessential and immaterial in the grand scheme of things and that the most precious elements of life are one’s family, loved ones, and close friends. In addition, heart and soul, the commitment and dedication to family, friends, and community service are special core values and are the critical elements that will revive the areas hardest hit by Mother Nature and support the arduous task of rebuilding communities and the lives within. Another painful lesson learned in the aftermath of Katrina is that much of the destruction could have been avoided had the local, state, and federal governments heeded the long-held warnings that New Orleans was indeed in danger of massive flooding should it take a direct hit from a massive hurricane and that complete reconstruction of the coastline and levee system was required to prevent such devastation. Moreover, required evacuation, as was done with hurricane Rita, would no doubt have saved countless lives. Although there is no dispute and disagreement now as to what should have been done, such pronouncements
232 • Clinical Colorectal Cancer November 2005
are easy to make in hindsight. Where were the visionaries who could have and should have made a difference in preventing and/or avoiding these horrific disasters? How can the lessons learned from Katrina and her sister hurricanes help in our fight against colorectal cancer? First, there is no question that the single best way to treat colorectal cancer is to prevent its occurrence and/or detect it at the earliest stages. In this regard, we as physicians need to be the voice of reason and vision and continue to educate the public with the information that colorectal cancer screening and early detection remains the best way for us to cure this disease. When caught at an early stage, this disease can be cured in as many as 90% of patients. Unfortunately, very little in the way of resources from the federal and private sectors has been focused on developing a comprehensive nationwide plan for effective screening, with virtually the lion’s share of the key financial resources used for research and development of new treatment strategies. Yes, it is true that tremendous progress has been made in the treatment of advanced disease in just the past 5-7 years with the introduction of novel cytotoxic chemotherapy and biologic agents; however, even though significant advances have been made in improving the 2-year survival of patients, this progress remains incremental at best, and we have yet to impact the actual cure rate of patients with advanced and metastatic disease. One approach that has been used to improve patient curability is to advance the optimal combination regimens identified in the metastatic disease setting into the neoadjuvant and adjuvant settings so as to prevent the recurrence of disease. As with Katrina and her aftermath, a broad vision of where we are heading with respect to developing truly effective detection, prevention, and treatment strategies is desperately needed if we are to really impact the eventual cure of patients with colorectal cancer.
Edward Chu, MD Editor-in-Chief