Features, South Africa

Cancer Treatment: Making it Personal

Innovation in cancer treatment and technology is one of the key drivers towards personalised medicine and care.

Cancer Treatment - EHN

Cancer is responsible for killing more people globally than AIDS, malaria and TB combined. According to CANSA, more than 100,000 South Africans are diagnosed with cancer every year; for women it’s mostly breast and cervical cancer while for men it’s prostate and colorectal. And out of those South Africans diagnosed with cancer, only 60% are likely to survive.

The prominence of cancer is largely due to environmental factors linked to unhealthy eating practices, sedentary lifestyles, smoking and the excessive intake of alcohol – the contributing factors for most non-communicable diseases (NCDs). However, the increase in people being diagnosed with cancer is also linked to dramatic improvements being made in cancer diagnostic technology over the years, which allow for earlier interventions that lead to improved patient outcomes.

Yet despite advances being made in cancer detection practices, it’s still a very complex process because often the cancerous cells can’t be detected until it’s too late for effective treatment. For example, with the prostate it’s very difficult to visualise the potentially cancerous areas; and because the biopsy needle is so small it could easily miss the cancerous tissue that’s essential for diagnosis.

It’s therefore essential for innovative researchers and health tech firms to continue investing in the development of non-invasive cancer screening methods that can allow for more treatment options, less complications, and a more cost-effective treatment plan overall.

Early detection can be a life saver

A number of leading health tech organisations have already started investing in improved cancer detection technology to overcome the uncertainty and inaccuracy of diagnosing cancer. Unsurprisingly, Philips is one such organisation that is leading the way with its Philips Invivo UroNav technology in prostate cancer detection. The high-tech fusion biopsy solution uses magnetic resonance imaging, along with live ultrasound guidance in conjunction with electromagnetic tracking to plan, guide and document prostate biopsies. The solution not only reduces the risk of erroneous initial biopsies that are responsible for unnecessary repeated biopsies, but also allows doctors to identify specific areas within the prostate that are suspicious and require further evaluation.

The BioJet 3D MRI Fusion Prostate Biopsy System is another prostate cancer diagnostic tool that combines MRI and real-time ultrasound. The system consists of a laptop with BioJet software and a special electronic stepper that holds the transrectal ultrasound. By adding the patient’s MRI prostate results to the BioJet Fusion programme lesions can be mapped out and combined with the results from the transrectal ultrasound before a biopsy, providing an accurate target area. A ‘grid’ is then placed over the patient’s perineal area and coordinates are used to locate the cancer area, similar to a GPS tracker.

For breast cancer, there’s been a global movement towards utilising Automated Breast Ultrasound (ABUS) screening technology along with mammograms for early detection in women with dense breasts. When using just a mammogram, the dense breast tissue can obscure tumours making it more difficult for radiologists to make a diagnosis. The ABUS probe moves over the breast and records images that can be used to check the entire breast for small lesions, as well as for 3D reconstructions and rotations.

There have also been a number of innovations that allow patients to screen themselves for cancer in the comfort of their own home. Local innovator, UDoTest, is one such organisation that provides a variety of self-screening home tests, including a clinically-proven and non-invasive Faecal Immunochemical Test (FIT), called the UDoColonTest. The FIT has a simple, toilet water collection method that allows patients to perform their own colon cancer screening and then send it off to a lab for analysis.

Innovative tech advancements

South African private hospitals have been at the forefront of using state-of-the-art cancer treatment technology to not only detect, but also to accurately treat different types of cancer. One such example is the Life Healthcare Group who has rolled out the Novalis Tx ™ Stereotactic RadioSurgery unit in a number of their hospitals across the country. The technology provides advanced radiation therapy that targets difficult to reach tumours anywhere in the body without harming surrounding healthy tissue. The use of such technology is helping to treat cancer patients with tumours that were previously deemed inoperable.

The Hummingbird Cancer Centre in Cape Town is using another innovative non-invasive treatment option for cancer patients called Photodynamic Therapy (PDT). As part of the treatment, patients are given a bio-engineered chlorophyll photosensitising agent that collects selectively in cancer tissue. When exposed to infra-red laser light, the agent activates and releases singlet oxygen that destroys cancer cells while leaving normal tissues largely unaffected. One of the best features of this technology is that patients experience almost no pain or side effects, both of which are common with traditional cancer treatment.

Robotic systems have also come a long way in facilitating complex keyhole surgery using a minimally invasive approach. A number of private hospitals, including Mediclinic Durbanville, have introduced the da Vinci Surgical system into their operating theatres to improve patient outcomes. Trained surgeons are able to manoeuvre the robot’s mechanical wrists as precisely as if they were the one’s  physically performing surgery , but it’s all done three times smaller and the 10X magnification of the inside of the body creates a much clearer surgical path. As robotic keyhole surgery is less invasive than traditional surgery, patients are often discharged the next day and are less likely to suffer from infection.

Development of personalised medicine

While conventional surgery, radiation and chemotherapy are still the default treatment options for cancer, there has been progress towards personalised medicine for patients battling the disease. The need to develop treatment regimens around an individual to optimise treatment and reduce side effects is a primary driver for the proliferation of new tech. Because at the end of the day every patient is biologically different and there really isn’t a one-size-fits-all treatment plan.

South Africa’s progress towards personalised cancer treatment is in the form of therapeutic radiopharmaceuticals. A biotechnology company called BGM Pharma has partnered with the South African Nuclear Energy Corporation (NECSA) and the University of Cape Town (UCT) to develop what is being referred to as next-generation chemotherapy. Called GluCAB, the molecular compound will operate as a two-stage mechanism by first identifying cancerous cells and then providing therapeutic doses of ionising radiation to kill malignant tumour cells. As such it will essentially seek, identify and treat solid mass tumours such as those found in breast and ovarian cancer. The benefit of such treatment is that it’ll help reduce patient recovery time, increase survival rates and lower the side effects of cancer treatment.

The CSIR and UCT have also partnered on a project to develop personalised cancer treatment. By studying the genetic mutations associated with some cancers, the partnership believes they’ll be able to identify chemotherapeutic agents that can be tailored to work against cancer cell mutations.

Integrative care is the future

While innovation in cancer treatment and technology is one of the key drivers towards personalised medicine and care, it’s still a relatively new trend that is complex to navigate towards because there isn’t only one approach. Global cancer expert and co-discoverer of salvestrols, a phytonutrient found in plants, Prof Dan Burke, is one of a growing number of healthcare practitioners who believe integrative care has room for clinically proven alternative therapies. Prof Burke is an outspoken advocate for herbal supplements, like Curcumin, that have been scientifically proven to prevent the mutation of cancer. Not only have such herbal properties been clinically proven to assist in cancer treatment, but they are actively being used to develop more effective, targeted and personalised cancer drugs.

While Prof Burke isn’t alone in his more natural cancer treatment beliefs, every cancer treating physician has their own approach to treatment. Yet with the evolution towards multidisciplinary care it’s important for doctors to collaborate to ensure a holistic cancer treatment plan for their patients’ road to recovery. While still a relatively new concept, the Hummingbird Cancer Centre in Cape Town has incorporated the ethos of integrative cancer treatment into their service by bringing together clinicians, dieticians and other healthcare providers to aid the patient with their physical, psychological, nutritional and emotional well-being along their road to recovery.

The heightened focus on mental and physical wellness is also extending beyond the walls of treatment facilities to encourage patients to follow a healthier lifestyle. This is part of a paradigm shift that’s moving the focus away from curative treatment towards preventative interventions to ensure a healthier population that’s less likely to suffer from cancer and other NCDs. A healthier population means a more productive nation that isn’t crippled by the staggering costs associated with the private sector or the inefficiencies of the public sector.

While improved patient outcomes and cost reductions play an important role in the evolution of innovative cancer treatment, what it really comes down to is facilitating patient-centred care. The American Society of Clinical Oncology (ASCO) President, Dr Peter Yu, sums it up perfectly in his statement: “I believe the best clinical results are achieved for each patient when the patient’s personal values and goals are met. That is really what quality of care is all about: achieving outcomes that matter to patients.”

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