[0:05] If you've been affected by cancer, or you know someone who's been affected by cancer, then stay tuned. I'm going to talk about this [0:14] Tension, this, [0:16] Prustration that sometimes seems to be apparent between individuals who are going through a cancer journey and the difficulties they get [0:26] Or they perceive they get entertaining, [0:29] And welcome to my podcast and videocast station. I really do appreciate you tuning in. I'm doing this as a podcast, so if you're listening, I will... [0:47] I will cover all the detail that you need to hear. If you happen to be watching this, you will get a few slides as well. [0:55] So without any further ado, let's get on and have a look at... [1:00] What this is all about. [1:03] There are a number of things that people talk about when, um, [1:09] There's this sense that [1:12] Well, [1:13] Doctors are not giving patients [1:17] The very best of care. All that that [1:21] Care is being held back or is not being delivered or processed through the standard protocols for access to patients as quickly as it should happen. [1:31] Fact verse. [1:33] Fallacy 5 myths. [1:36] Surrounding. [1:37] Cancer care are well-meaning arguments in this space that can [1:42] Work against the patients that they're meant to be protecting. So let's have a look at it. [1:49] Fallacy 1, patients are dying, so lower the bar. This is talking about trying to bring medications online sooner, [1:58] For the benefit of those individuals, the argument sounds fair, reasonable and compassionate, [2:04] If people are dying from a disease, surely we'd approve any drug that shows even a hint of benefit. [2:11] But that's not without a flip side. What it does create is a real opportunity cost and [2:19] The way to understand that is if we start to approve drugs [2:23] That are weak, we tend to remove incentives [2:28] To develop drugs that are genuinely more powerful and more likely to improve survival. [2:35] Lawring the standard for [2:39] And a new drug will lower the standard for subsequent drugs and also reduce the efforts to try and make sure we get the best possible care. [2:52] Lurring the bar can also just mislead patients directly. Patients may spend their time and resources on treatments that were never going to help. So these might be expensive. [3:06] They may not be... [3:08] They may cause all sorts of inconvenience to an individual [3:13] And with the bar lowered, may not have a great impact and so may really [3:19] Not be beneficial to the patient. [3:21] And that patient's individual journey. [3:24] Specifically, [3:26] Fallacy number two, the cancer is rare, so lower the bar. And look, it's fair to say that rare cancers do require some flexibility, and large randomized trials are hard to run when you just don't get many of these uncommon cancers. [3:47] However, there are regulatory pathways in place for these, um, [3:54] SORTI SORTI SITUATIONS. and they can be used if [3:59] Really deemed appropriate. [4:01] And remember though that flexibility is not the same as [4:06] As no evidence and [4:09] Evidence always will be important because it's how we really advance our knowledge base and make our best possible decisions. [4:16] Remember that global collaboration between centres may make even a locally rare cancer [4:23] Significant enough in numbers to generate some proper evidence. And that's to everyone's good. So the issue... [4:32] Maybe more around coordination rather than [4:37] Liwering a bar just because something is not common. [4:42] Also keep an eye out for cancers that if you like a sliced or redefined into artificial rarity, there can be common cancers that are then split into smaller molecular subtypes and that may cause confusion and that should not become an excuse for avoiding proper trials. [5:06] Thank you. [5:06] Fallacy number three, the incidence is rising, so start screening. Well, this sounds like a great idea. Rising incidence in a group is a real signal. We know that screening works. We do it for... [5:20] We do it for skin screening. So it is a reasonable idea and if we do notice, um, [5:28] That a cancer becomes more regular in a particular age group, ethnicity or population, we should take that on board and be thinking about it. But remember, detection alone is not [5:39] The goal. It has to be. [5:42] More nuanced than that, a useful screening test needs to capture cancers in just the right spot, the Goldilocks spot. Because if you identify cancers, [5:53] That are never going to cause a problem, then... [5:57] Why are you trying to identify them? And if you're identifying cancers that are so aggressive that you'll never identify them in time, then you're going to miss them as well. So there's a real Goldilocks spot to try and make sure that [6:12] The detection is directed at just the right point. [6:17] "Sort of cancer in the right sort of population." [6:21] Also, that screening really needs to reduce mortality or very importantly a considerable impact on morbidity. So screening decisions require weighing life expectancy, interventions, mortality benefit and/or significant mortality, morbidity benefit, [6:41] Perhaps even cost actually, because that's important as well, because it may be considered in a population, large population base. [6:49] And there would be an opportunity cost associated with that. What else is missing out? [6:56] Uh, [6:57] Fallacy number 4 and fallacy number 5, evidence-seeking is not anti-patient. [7:05] And. [7:06] Expo. [7:09] Um, [7:10] Expertise does not transfer automatically. And what this sort of means is that [7:17] When doctors are asking for more evidence about new treatments, [7:24] That shouldn't be framed as not caring for patients. In reality, it's how we make sure that we're making decisions that are truly helping people rather than just offering false hope. So, [7:35] Those listening may have come across [7:39] Things like ivermectin, fembendazole as therapies being used and promoted in social media for [7:48] A broad range of cancers. It's reasonable to be asking about whether these agents actually work because [7:56] We need that trotled out or that evidence base, [7:59] To really be able to give people the best information to make the best decisions for them. [8:05] It's also important to think about scientific standards and that they need to stay consistent. If we demand evidence for an unproven remedy, we owe the same price. [8:16] To cancer drugs. So you wouldn't expect a brand new blood pressure therapy to hit the market and [8:25] Without proper evaluation, why would you expect a cancer therapy to do the same? [8:30] Without buying into the discussion, we know there's a lot of controversy still about the [8:37] COVID mRNA vaccine. So... [8:41] How much evidence was there and how much evidence is now becoming apparent which has colored those waters or clouded those waters of complicated space. [8:52] It's also worth noting that being an excellent clinician in one area, for example, breast cancer therapy, doesn't automatically make someone an expert in trial design, screening processes, or population level public health decisions. These are different hats, different skill sets, and... [9:11] Although, [9:13] H. [9:14] Individual may have their area of expertise. Speaking to other areas of expertise may actually be quite [9:30] Excellent clinician. [9:31] Maybe. [9:33] In a very good position to give excellent feedback about breast cancer therapy, [9:38] But as they offer particular advice around screening or drugs, [9:44] There. [9:46] View may not be appropriate or applicable to a broader health discussion. [9:52] Interesting thought. [9:54] Um, [9:55] So those differences need to be taken into context. [10:01] . [10:02] It's important that we understand these compassionate arguments around cancer care because it is a big issue. [10:28] And rising incidence of a particular condition do deserve serious attention, but neither alone justifies lowering the evidence bar because it just [10:39] Lowest quality or all? [10:41] Across the board and that's not to anyone's best outcome. [10:45] Asking questions or requesting evidence is a form of care. It's not an obstacle to it. So understanding more is always a good thing. [10:55] And remember that clinical skills and public health expertise and trial design are all different things and it's the combination of those things being brought together that will generally provide the best practice. [11:09] Unified evidence and information to bring to individuals and to the public. [11:16] Well, [11:18] I'm going to wrap it up there on the five fallacies of cancer. [11:24] And I hope you found that. [11:26] Interesting. If you know someone who this might be helpful for, please share it with them and I'd love it if you subscribe and like. [11:36] For now though, I'm going to wish you the very best. I do hope you live as well as possible. [11:41] For as long as possible, until next time. [11:44] Bye for now and take care.