Human Nature and Cancer (non-compliance)
This is such an under-discussed part of cancer care. Yet is probably THE most important factor in control and cure.
Paradoxically it is one of the least well understood or for that matter studied areas. This is such a huge field that I can guarantee this particular theme in my blogs will have more sequels than Die Hard.
Let me start by recounting a story that Dr Scott Howard, a great paediatric oncologist from St.Jude’s Children’s hospital told me recently.
St.Jude’s have been working with Morocco (amongst other places) through their Cure4kids outreach program (https://www.cure4kids.org/ums/home/) when during their reviews they noticed that not much progress had been made with overall survival in Hodgkin’s Disease despite updates to protocols and good clinical infrastructure.
Now Hodgkin’s disease is a very chemo-sensitive cancer and this shouldn’t have been the case.
It turns out what was happening was that the patients were presenting, being diagnosed then treated with their first cycle of chemotherapy which, being such a sensitive cancer, promptly shrank the cancer immediately.
Despite being told that they had to come back to complete all the courses the patients didn’t bother, assuming that because the swelling had gone they were cured!
Of course when it reappeared two months later they come back for another cycle; and so it went on until of course a cancer that is perfectly curable if you have the full treatment schedule became resistant and eventually caused the patient to succumb around the two year mark.
We’ve always known that compliance in medicine is a big problem. How many of us have started taking antibiotics only to stop half way through because, a) we are now feeling better and, b) often the antibiotics are making us feel lousy.
The problem in the story above is that the consequences for non-compliance are lethal. What’s interesting is that non-compliance in cancer therapy is probably more widespread than we realize. The literature is not exactly overflowing with evidence but the David Taylor and colleagues at the London School of Pharmacy have written a nice review on this subject (link to pdf); well worth a read.