“What was cancer, Grandpa?” These were words I hoped to hear from my grandchildren. As a practicing physician for over forty-five years, I wasn’t sure whether futuristic care would include finding a cure for cancer. But that time has arrived.
Unfortunately, this realization came from personal experience as my wife was diagnosed with terminal cancer four years ago. Initially in 2022, we thought it was a slow-growing thyroid cancer that would take 3 hours of surgery to remove. But 9 1/2 hours later, it was clear that it was highly aggressive and rapidly spreading.
My wife and I were fortunate to be at a large academic medical center, where an oncology team was assembled to develop a plan to best treat her specifically diagnosed anaplastic thyroid cancer. We waited three weeks postoperatively for healing, then began seven weeks of concurrent radiation and chemotherapy, hoping they would stop the cancer. They didn’t. It spread to the soft tissue of the leg, and then cancer was found in the lymph nodes of the lung.
The hospital is renowned as one of the best in the state, but given the evolving metastasis, it was decided to seek an opinion from a national cancer center in another state, where the very few physicians in our country who were experts in this field were located. There, in consultation with her local doctors, it was agreed to start IV immunotherapy and begin oral “targeted” medication.
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Advances in research and molecular biology have shown that cancers are caused by mutations in cellular DNA. Typically, if you accidentally cut yourself, your body’s DNA signals cells to multiply to help the area heal, and then a “stop button” ends the process. Cancer occurs when the “stop button” doesn’t work.
Our expectation was that the hospital is always at the cutting edge of medical technology, ensuring that its patients receive state-of-the-art care. Therefore, her postsurgical biopsy sample was sent for “biomarker analysis” to identify any actionable mutations driving her cancer. Indeed, a mutation was found, and two “targeted” medications were identified that might reengage the DNA “stop button.”
The first “targeted” medication had significant side effects, so it had to be stopped after four weeks. However, at that time, blood tests (ctDNA) and PET scans, which had previously been positive, were now negative. Four weeks!
The second “targeted” medication replaced the first. Over the past two years, blood tests and scans have shown “no evidence of disease.”
The triumphs of medicine and research teams around the world are now saving lives, and specialists and “centers of excellence” are becoming more expert across the nation. Still, much of the public, including even medical doctors, remains unaware of these triumphs.
But as usual for this celebration, the center stage features the appearance of profit and greed, accompanied by the dreaded word from insurers, “DENIED.” The “biomarker analysis” performed on the biopsy sample cost about $400. It is likely more expensive today. Insurance companies have denied payment for this test, even though “biomarker analysis” can enhance treatment options and even save a person’s life. Not only that, some organizations, such as HMOs, will not cover a “biomarker analysis” because of the cost, even though savings on radiation and chemotherapy easily offset the cost of the “targeted” medication.
Smaller hospitals won’t perform this testing because it’s too expensive, and some doctors don’t order it out of sheer ignorance. That’s why you must be your own advocate.
- If you’re advocating for yourself or a loved one, have a discussion with the doctor who ordered the biopsy, usually a surgical specialist or oncologist, before the sample is taken. This ensures the sample is collected correctly and that “biomarker analysis” is performed. Note that, due to confusing medical terminology, several terms have been created for this testing, such as “next-generation sequencing” (NGS), molecular testing, and genomic or molecular profiling.
- Check with your insurance company to confirm that your doctor has completed any required “prior authorization” forms.
- If you are enrolled in Medicaid, certain states are required by law to provide a “biomarker analysis” of your biopsy. Some pharmaceutical companies will also cover this analysis if your insurance denies it.
- Make sure you receive a copy of the “biomarker analysis” and that your doctor interprets it accurately. As previously mentioned, this information is new to many in the medical profession and should be explained by a specialist.
Using artificial intelligence is a useful tool, but it is not the final word on navigating your health into the 21st century, especially concerning futuristic care.
I am confident that my grandchildren will possess a thorough understanding of it, as those of my generation helped discover the key to the DNA stop button. I now expect to hear the question from them: “What was cancer, Grandpa?”
Gene Uzawa Dorio is an internal medicine physician.
