Oncologists are guardedly optimistic about AI. But will it drive real improvements in cancer care?


Over the course of my 25-year career as an oncologist, I’ve witnessed a lot of great ideas that improved the quality of cancer care delivery along with many more that didn’t materialize or were promises unfulfilled. I keep wondering which of those camps artificial intelligence will fall into.

Hardly a day goes by when I don’t read of some new AI-based tool in development to advance the diagnosis or treatment of disease. Will AI be just another flash in the pan or will it drive real improvements in the quality and cost of care? And how are health care providers viewing this technological development in light of previous disappointments?

To get a better handle on the collective “take” on artificial intelligence for cancer care, my colleagues and I at Cardinal Health Specialty Solutions fielded a survey of more than 180 oncologists. The results, published in our June 2019 Oncology Insights report, reveal valuable insights on how oncologists view the potential opportunities to leverage AI in their practices.

Limited familiarity tinged with optimism. Although only 5% of responding oncologists describe themselves as being “very familiar” with the use of artificial intelligence and machine learning in health care, 36% said they believe it will have a significant impact in cancer care over the next few years, with a considerable number of practices likely to adopt artificial intelligence tools.

The survey also suggests a strong sense of optimism about the impact that AI tools may have on the future: 53% of respondents said that such tools are likely or very likely to improve the quality of care in three years or more, 58% said they are likely or very likely to drive operational efficiencies, and 57% said they are likely or very likely to improve clinical outcomes. In addition, 53% described themselves as “excited” to see what role AI will play in supporting care.

An age gap on costs. The oncologists surveyed were somewhat skeptical that AI will help reduce overall health care costs: 47% said it is likely or very likely to lower costs, while 23% said it was unlikely or very unlikely to do so. Younger providers were more optimistic on this issue than their older peers. Fifty-eight percent of those under age 40 indicated that AI was likely to lower costs versus 44% of providers over the age of 60. This may be a reflection of the disappointments that older physicians have experienced with other technologies that promised cost savings but failed to deliver.

Hopes that artificial intelligence will reduce administrative work. At a time when physicians spend nearly half of their practice time on electronic medical records, we were not surprised to see that, when asked about the most valuable benefit that AI could deliver to their practice, the top response (37%) was “automating administrative tasks so I can focus on patients.” This response aligns with research we conducted last year showing that oncologists need extra hours to complete work in the electronic medical record on a weekly basis and the EMR is one of the top factors contributing to stress at work. Clearly there is pent-up demand for tools that can reduce the administrative burdens on providers. If AI can deliver effective solutions, it could be widely embraced.

Need for decision-support tools. Oncologists have historically been reluctant to relinquish control over patient treatment decisions to tools like clinical pathways that have been developed to improve outcomes and lower costs. Yet, with 63 new cancer drugs launched in the past five years and hundreds more in the pipeline, the complexity surrounding treatment decisions has reached a tipping point. Oncologists are beginning to acknowledge that more point-of-care decision support tools will be needed to deliver the best patient outcomes. This was reflected in our survey, with 26% of respondents saying that artificial intelligence could most improve cancer care by helping determine the best treatment paths for patients.

AI-based tools that enable providers to remain in control of care while also providing better insights may be among the first to be adopted, especially those that can help quickly identify patients at risk of poor outcomes so physicians can intervene sooner. But technology developers will need to be prepared with clinical data demonstrating the effectiveness of these tools — 27% of survey respondents said the lack of clinical evidence is one of their top concerns about AI.

Challenges to adoption. While optimistic about the potential benefits of AI tools, oncologists also acknowledge they don’t fully understand AI yet. Fifty-three percent of those surveyed described themselves as “not very familiar” with the use of AI in health care and, when asked to cite their top concerns, 27% indicated that they don’t know enough to implement it effectively. Provider education and training on AI-based tools will be keys to their successful uptake.

The main take-home lesson for health care technology developers from our survey is to develop and launch artificial intelligence tools thoughtfully after taking steps to understand the needs of health care providers and investing time in their education and training. Without those steps, AI may become just another here today, gone tomorrow health care technology story.

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Atrocious State of Cancer Treatment in the U.S.



Story at-a-glance

  • Despite a decades-long war on cancer, and the “most advanced” treatments known to 21st-century oncologists, many cancer diagnoses remain a death sentence
  • Patient requests for possible experimental, natural or outside-the-box treatments are typically denied by oncologists who refuse to deviate from the hospital’s standard protocol
  • The film “Surviving Terminal Cancer” follows the story of those who have survived terminal cancer by bucking the system and taking their health and cancer treatment into their own hands

Being diagnosed with glioblastoma multiforme, a type of brain tumor, is considered a death sentence by modern medicine.

Despite a decades-long war on cancer, and the “most advanced” treatments known to 21st century oncologists, people who develop this aggressive, fast-growing cancer are given a prognosis of about 15 months to live — if they’re lucky.

Aggressive treatment, including surgery, radiation and chemotherapy, is often started, even though oncologists know it won’t cure the disease. If you ever find yourself in this type of nightmarish scenario, you can imagine the desperation you would feel to find something, anything, that might offer hope.

Most people turn to their oncologists or neurosurgeons with such requests for possible experimental or outside-the-box treatments, but you’re unlikely to receive any help that deviates from the hospital’s standard protocol.

It’s not that such treatment options don’t exist; they do. The problem is that the oncologist can’t, or won’t, prescribe them. To do so would risk his or her reputation and even medical license, should you decide to sue.

The film interviews a number of oncologists that carefully describe their predicament. But the problem is even larger than this. Modern cancer care is not set up to treat you, an individual. Their primary goal is to validate experimental therapies for future cancer patients many years down the road.

Due to regulatory red tape, drug-company greed, failures in the scientific process and lack of a universal will to do what’s best for each and every patient, modern cancer care fails an unacceptable percentage of the time.

As Albert Einstein said, the definition of insanity is doing the same thing over and over again and expecting different results. This describes modern cancer treatment in a nutshell.

How One Man Survived Terminal Cancer

Ben Williams, Ph.D., professor emeritus of Experimental Psychology at University of California, San Diego, shouldn’t be here today. He should be one of the statistics — 1 of the more than 15,000 people who die from glioblastoma multiforme in the U.S. every year.1

Yet, he’s alive — 19 years after his initial glioblastoma multiforme diagnosis. His survival was brushed off as a rare fluke by his doctors, but Williams believes otherwise.

In his book “Surviving Terminal Cancer: Clinical Trials, Drug Cocktails, and Other Treatments Your Oncologist Won’t Tell You About,” he details the multi-faceted strategy he used to overcome the disease. You can hear him tell his story first-hand in the film “Surviving Terminal Cancer,” above.

It’s becoming increasingly clear that in order to outsmart cancer, you’ve got to attack it from multiple angles, especially in the case of complex brain cancer. And that’s what Williams did.

He described a mushroom extract that’s used routinely to treat cancer in Japan. It has zero toxicity, but it’s not even mentioned in the U.S.

He did his own research, finding out about the potential to use existing non-cancer medications off label to treat the deadly disease. Once a patent expires on a drug, its potential to rake in major profits plummets. As such, drug companies typically abandon them in favor of newer, more profitable pursuits.

Abandoned Drugs Show Promise but Oncologists Won’t Prescribe Them

Some of these abandoned drugs have shown promise for glioblastoma multiforme, but they’re not offered to U.S. patients. While I’m not in favor of over-prescribing medications, if you’re facing a deadly prognosis you’re probably willing to risk the side effects if it gives you a chance for survival.

High-dose tamoxifen, a breast cancer drug, is one such medication that has shown some promise in treating glioblastoma multiforme.2

The anti-malaria drug chloroquine is another.3 There’s even a good chance your neuro-oncologist may be aware of the promising studies done with these drugs, but he or she won’t offer them as a potential treatment because they’re considered experimental. As Williams said:

“It made absolutely no sense to me not to use everything that might have a benefit as long as the toxicities were acceptable. Why wouldn’t anyone want to add them? It seemed to be totally irrational that people didn’t use everything that was available.”

When Modern Medicine Fails Them, Cancer Patients Turn to Self-Medication and the Black Market

In order to survive, Williams turned to self-medicating, a dangerous prospect by any account but, again, when your life is at stake you’re willing to take the risk. And his story is not unique.

Many have traveled to other countries, forged prescriptions, feigned illnesses to get access to different medications and even traded medications and nutraceuticals on the “black market” in order to have even a chance at survival.

In Williams’ case, his daily cocktail of off-label medications and natural products worked. In just six months, his brain tumor had disappeared and it hasn’t been back since.

There are more than a handful of others who have defied odds and lived long term with glioblastoma multiforme, and they’ve taken matters into their own hands too.

Williams now spends the bulk of his time trying to help others with terminal cancer, and he makes his book, which he updates annually, free to cancer patients in need.

Natural Cancer Fighters Overlooked by Modern Medicine

Nature is an invaluable resource for fighting cancer, yet natural products, even those that have been intensely studied, are also left out of cancer patients’ treatment plans. Curcumin — one of the most well-studied bioactive ingredients in turmeric — is one glaring example.

It exhibits over 150 potentially therapeutic activities, including anti-cancer properties.

As noted by Dr. William LaValley — a leading natural medicine cancer physician whom I’ve previously interviewed on this topic — curcumin is unique in that it appears to be universally useful for just about every type of cancer.

Superficially, this appears unusual considering the fact that cancer consists of a wide variety of different nuclear genetic defects. One reason for this universal anti-cancer proclivity is curcumin’s ability to decrease the primary mitochondrial dysfunction that is likely one of the foundational causes of cancer. Once it gets into a cell, it also affects more than 100 different molecular pathways.

And, as explained by LaValley, whether the curcumin molecule causes an increase in activity of a particular molecular target or decrease/inhibition of activity, studies repeatedly show that the end result is a potent anti-cancer activity. Moreover, curcumin is virtually non-toxic, and does not adversely affect healthy cells, suggesting it selectively targets cancer cells — all of which are clear benefits in cancer treatment.

Research has even shown that it works synergistically with certain chemotherapy drugs, enhancing the elimination of cancer cells. If you have cancer, curcumin is one substance you should be taking, but your oncologist won’t recommend it.

To Survive Cancer, Many Must Defy Their Doctors

Should you bring up the fact that you are using approaches to fight cancer that are outside of your oncologist’s realm of experience — things like supplements, medical marijuana, herbal preparations, and more — you might be scolded, berated, threatened or even fired from the practice.

Williams never told his oncologists about his self-prescribed treatment; he knew it would fall on deaf ears. The cancer industry should be learning from the people who have beaten the odds and survived terminal cancer — studying their methods and trying to apply them to others — but instead they’re ignored.

It’s an unfortunate state of affairs when patients must actively defy their doctors in order to survive. As Williams explained, going against the advice of his doctors was initially an act of desperation, but it was necessary to save his life. This certainly applies to the majority of conventional oncologists, but there are exceptions — doctors who are blazing a new trail to find a cancer cure.

This includes Dr. Marc-Eric Halatsch, a professor and senior consultant neurosurgeon at the University of Ulm, Germany, who, along with colleagues have developed a new treatment protocol for relapsed glioblastoma.

It’s based on a combination of drugs (very similar to the early HIV treatments) “not traditionally thought of as chemotherapy agents, but that have a robust history of being well-tolerated and are already marketed and used for other non-cancer indications.”4 As noted in the featured film, even though the protocol uses mainstream medications, he’s put his reputation on the line to step outside the conventional cancer-treatment box.

Cancer Patients Should Have Access to the Best of Eastern and Western Medicine

Dr. Raymond Chang, who is featured in the video above, is one such pioneer in the integration of Eastern and Western medicine. He is known for his work on anti-cancer Chinese botanicals especially involving bioactive polysaccharides and medicinal mushrooms.

He and colleagues with the Institute of East-West Medicine have created the Asian Anti-Cancer Materia Database, which brings together traditional Asian medicines that have potential anti-cancer activity into one database that can be accessed by all.5 In his book, “Beyond the Magic Bullet ― The Anti-Cancer Cocktail,” Dr. Chang explained:

“While scientists win occasional skirmishes in the battle against cancer, the overall war continues to go badly. Stories abound about revolutionary drugs that may be available in the future, but offer no real help to those who have cancer today. At present, conventional approaches continue to rely on a narrowly focused strategy of treatments, with doctors using, at best, only one or two drugs or other therapies at a time.

While this may be acceptable in a laboratory setting or a clinical trial, it has done little to diminish the number of people who die each year from this dread disease. Recently, however, conventional medicine’s core strategy has been re-examined, and a new, potentially more effective approach has emerged ― one that combines the best of Eastern wisdom with Western science.”

More Than Half a Million People Expected to Die From Cancer in 2016

In 2016, nearly 1.7 million new cases of cancer are expected to be diagnosed in the U.S., while nearly 600,000 will die from the disease.6  That is nearly 1,650 people dying EVERY DAY in the U.S. alone. Public health agencies claim that we are winning the war against cancer, but from 2003 to 2012 death rates from cancer decreased by only 1.8 percent per year among men and 1.4 percent per year among women.7

Meanwhile, the 2014 World Cancer Report issued by the World Health Organization (WHO) predicted worldwide cancer rates to rise by 57 percent in the next two decades.8

The report refers to the prediction as “an imminent human disaster,” noting countries around the world need to renew their focus on prevention rather than treatment only. Christopher Wild, Ph.D., director of the International Agency for Research on Cancer, told CNN:9

“We cannot treat our way out of the cancer problem. More commitment to prevention and early detection is desperately needed in order to complement improved treatments and address the alarming rise in cancer burden globally.”

There is so much you can do to lower your risk for cancer, but please don’t wait until you get the diagnosis — you have to take preventative steps now. Cancer doesn’t typically develop overnight, which means you have a chance to make changes that can potentially prevent cancer from developing in the first place. Most of us carry around microscopic cancer cell clusters in our bodies all the time.

The reason why we all don’t develop cancer is because as long as your body has the ability to balance angiogenesis properly, it will prevent blood vessels from forming to feed these microscopic tumors. Trouble will only arise if, and when, the cancer cells manage to get their own blood supply, at which point they can transform from harmless to deadly. It’s much easier to prevent cancer than to treat it once it takes hold.

Top Cancer Prevention Strategies

I believe you can virtually eliminate your risk of cancer and chronic disease and significantly improve your chances of recovering from cancer if you currently have it, by following these relatively simple strategies.

1.Eat REAL Food: Seek to eliminate all processed food in your diet. Eat at least one-third of your food raw. Avoid frying or charbroiling; boil, poach or steam your foods instead. Consider adding cancer-fighting whole foods, herbs, spices and supplements to your diet, such as broccoli sprouts, curcumin and resveratrol.

2.Carbohydrates and Sugar: Sugar/fructose and grain-based foods from your diet need to be reduced and eventually eliminated. This applies to whole unprocessed organic grains as well, as they tend to rapidly break down and drive up your insulin level.

The evidence is quite clear that if you want to avoid cancer, or you currently have cancer, you absolutely MUST avoid all forms of sugar, especially fructose, which are dirty fuels generating excessive free radicals and secondary mitochondrial damage.

3.Protein and Fat: Consider reducing your protein levels to 1 gram of protein for every kilogram of lean body mass, or one-half gram of protein per pound of lean body mass. Replace excess protein with high-quality fats, such as organic eggs from pastured hens, high-quality grass-fed meats, raw pastured butter, avocados, pecans, macadamias, and coconut oil.

4.GMOs: Avoid genetically engineered foods as they are typically treated with herbicides such as Roundup (glyphosate), and are likely to be carcinogenic and contribute to mitochondrial dysfunction. Choose fresh, organic, and preferably locally grown foods.

5.Animal-Based Omega-3 Fats: Normalize your ratio of omega-3 to omega-6 fats by consuming anchovies, sardines, wild Alaskan salmon or taking a high-quality krill oil and reducing your intake of processed vegetable oils.

6.Optimize Your Gut Flora: This will reduce inflammation and strengthen your immune response. Researchers have found a microbe-dependent mechanism through which some cancers mount an inflammatory response that fuels their development and growth.

They suggest that inhibiting inflammatory cytokines might slow cancer progression and improve the response to chemotherapy. Fermented foods are especially beneficial for gut health, and the fermentation process involved in creating sauerkraut produces cancer-fighting compounds such as isothiocyanates, indoles and sulforaphane.

7.Exercise and Move More: Sit less, move around more and try to take 10,000 steps a day.  Exercise also lowers insulin levels, which creates a low-sugar environment that discourages the growth and spread of cancer cells. In a three-month study, exercise was found to alter immune cells into a more potent disease-fighting form in cancer survivors who had just completed chemotherapy.

Researchers and cancer organizations increasingly recommend making regular exercise a priority in order to reduce your risk of cancer and help improve cancer outcomes. Exercise may also help trigger apoptosis (programmed cell death) in cancer cells. Ideally, your exercise program should include balance, strength, flexibility, and high-intensity interval training (HIIT). For help getting started, refer to my Peak Fitness Program.

8.Vitamin D: There is scientific evidence you can decrease your risk of cancer by more than half simply by optimizing your vitamin D levels with appropriate sun exposure. Your serum level should hold steady at 50 to 70 ng/ml, but if you are being treated for cancer, it should be closer to 80 to 90 ng/ml for optimal benefit.

If you take oral vitamin D and have cancer, it would be very prudent to monitor your vitamin D blood levels regularly, as well as supplementing with vitamin K2, as K2 deficiency is actually what produces the symptoms of vitamin D toxicity.

9.Sleep: Make sure you are getting enough restorative sleep. Poor sleep can interfere with your melatonin production, which is associated with an increased risk of insulin resistance and weight gain, both of which contribute to cancer’s virility.

10.Exposure to Toxins: Reduce your exposure to environmental toxins like pesticides, herbicides, household chemical cleaners, plastics chemicals, synthetic air fresheners and toxic cosmetics.

11.Exposure to Radiation: Limit your exposure and protect yourself from radiation produced by cell phones, towers, base stations, and Wi-Fi stations, as well as minimizing your exposure from radiation-based medical scans, including dental x-rays, CT scans, and mammograms.

12.Stress Management: Stress from all causes is a major contributor to disease. It is likely that stress and unresolved emotional issues may be more important than the physical ones, so make sure this is addressed. My favorite tool for resolving emotional challenges is the Emotional Freedom Techniques (EFT).

Have You Been Diagnosed With Cancer?

One of the most essential strategies I know of to treat cancer is to starve the cells by depriving them of their food source. Unlike your body cells, which can burn carbs or fat for fuel, cancer cells have lost that metabolic flexibility. Dr. Otto Warburg was given a Nobel Prize over 75 years ago for figuring this out, but virtually no oncologist actually uses this information.

You can review my interview with Dominic D’Agostino, Ph.D. below for more details. Integrating a ketogenic diet with hyperbaric oxygen therapy is deadly to cancer cells. It debilitates them by starving them of their fuel source. This would be the strategy I would recommend to my family members if they were diagnosed with cancer.

Watch the video discussion. URL:https://vimeo.com/119006145

Source:mercola.com

A Shortage of Oncologists


In the crucible of cancer treatment, the bonding of patients with physicians often makes the unendurable endurable. The difficulty of finding and then keeping the right oncologist can therefore be fraught. Yet this problem, not uncommon today, is on track to grow worse.

“My doctor is terribly overworked and isolated,” my friend Lucy said recently to the other members of our cancer support group. She worried that her doctor, the only gynecologic oncologist left at Indiana University’s Simon Cancer Center, would burn out. “He needs to have colleagues to help shoulder the patient load and also provide him a sense of community.”

Women with ovarian cancer are told repeatedly that we must find a specialist. Yet in many areas of the country, it is impossible. There are no ovarian cancer specialists in my small town in southern Indiana. Upon diagnosis in 2008, I was instructed to drive an hour and a half to the Simon Cancer Center in Indianapolis for the debulking operation that would be performed by a gynecologic oncologist.

Afterward, I was told that I could choose my surgeon or one of three other specialists at my state’s premier medical institution to oversee my chemotherapy regimen. At that time there were four experts treating patients with gynecological cancers there.

I picked a medical oncologist who specialized in ovarian cancer. When my doctor left for a position in another city, I was in a Phase I clinical trial, as I am now. I was assigned to the principal investigator of that trial, who happened to be a breast cancer specialist. It was unnerving to be enveloped in pink — cover-ups, forms, you name it — and told by staff members, who mistakenly assumed I was there for breast exams, to undress from the waist up. Yet her research had extended my life. After that doctor also departed, I was given to another breast cancer physician who has promised to examine my breasts only once a year.

Patients without the resources to travel, especially those with less common forms of cancer, must face greater challenges. Away from academic centers, many oncologists function as generalists who treat numerous cases of breast, prostate, lung and colorectal cancer, but who less frequently encounter esophageal, adrenal, oral, muscle, bone or brain cancers. This is an issue for patients who live in rural areas.

Are there disincentives for medical students that route them away from specializing in rarer or more lethal types of cancer, asked Dana, another member of my support group. We speculated that it must be distressing for doctors to work without colleagues.

At home and online, I was surprised to discover that the problem of finding a doctor extends to oncologists in general, not just to those with specific expertise.

In 2007, a study conducted by the American Society of Clinical Oncology (ASCO) anticipated that cancer occurrences would soon outpace oncology services. A 2014 follow-up analysis in the Journal of Oncology Practice predicted that demand will grow by about 40 percent, whereas supply may grow only about 25 percent by the year 2025. “Unless oncologist productivity can be enhanced, the anticipated shortage will strain the ability to provide quality cancer care,” the authors concluded.

The combination of an aging population and an inadequate number of newly trained professionals will harm overworked cancer physicians and underserved patients alike.

Putting on our activist hats, the members of my support group decided that we should lobby for more hires by writing a letter to the Simon Cancer Center, to be sent to the various administrators in charge of the medical school.

We included data showing that Indiana — even before the loss of our specialists — lagged near the bottom of American states in terms of board-certified gynecologic oncologists per million residents: We had about two physicians per million people, compared with a national average of about three and with about six to 10 in a few states at the top of the list.

At our next meeting, while six of us reviewed the letter, we listened in stunned silence as one of our group members told us that Lucy’s doctor had just decided to leave the Simon Cancer Center. Now there would be no gynecological oncologists there.

That night I considered the brilliant physicians who have directed my eight years of cancer treatment. Thanks to these smart and resourceful women, I have survived three years beyond the expiration date I had initially been given. I would not be alive today without their guidance and support.

The next week, when Lucy went online to the Simon Cancer Center home page and typed “ovarian cancer” into the Find a Doctor tool, she got a list of pediatric surgeons.

Like the other members of the support group, Lucy and I do not have a solution for the shortages in oncology. A microcosm of the cancer community, we can only call attention to the problem.

It is important to make the environments in which oncologists grapple with a sinister disease conducive to their well-being. Only then can they properly attend to the manifold concerns of current patients and expand the medical training of the physicians many others will need in the future.