Receiving a diagnosis of advanced melanoma can be overwhelming, but the joy of a clean 10-year scan is unparalleled. Such a milestone often signifies that the patient is free from detectable cancer, potentially marking the end of the annual anxiety associated with follow-up scans. However, even in these promising scenarios, oncologists often hesitate to use the term “cure,” opting instead for words like “remission” or “no evidence of disease.” This choice of language is not mere semantics; it reflects the complexities and uncertainties inherent in cancer prognosis.
The Weight of Words in Oncology
The reluctance to declare a patient “cured” stems from the medical community’s understanding of cancer’s unpredictable nature. Dr. Belinda E. Kiely and Dr. Martin R. Stockler, medical oncologists from The University of Sydney, highlight that the “risk of future recurrence—even when very small—makes oncologists reluctant to use the word cure, fearing it will be interpreted as a promise, and particularly one that might be broken.” This cautious approach aims to provide hope tempered with realism, acknowledging that while current tests show no evidence of disease, microscopic cancer cells could still exist undetected.
Defining ‘Cure’ in the Context of Cancer
The term “cure” lacks a universally accepted definition in oncology. For some experts, it implies that patients will have a normal life expectancy unaffected by cancer. Achieving the confidence to declare this “requires very long-term follow-up,” notes Dr. James Larkin, a medical oncologist at The Royal Marsden Hospital in London.
The National Cancer Institute (NCI) defines a cure as having “no traces of your cancer after treatment and the cancer will never come back.” In contrast, the American Society of Clinical Oncology describes it more conservatively as when “a person’s cancer has not returned for at least 5 years after treatment.” This variability underscores the challenge oncologists face in communicating a definitive cure to patients.
The Psychological Impact of Terminology
The language used in discussing cancer outcomes significantly influences patient emotions and expectations. Terms like “remission” acknowledge the success of treatment while maintaining vigilance for potential recurrence. This careful wording helps manage patients’ hopes and prepares them for ongoing monitoring. A study published in the Mayo Clinic Proceedings emphasizes the importance of compassionate communication, advising clinicians to avoid phrases that may inadvertently cause fear or a sense of hopelessness. Instead, fostering an open dialogue that recognizes patient emotions and provides continuous support is recommended.
Advancements Offering Hope
Despite the cautious language, advancements in cancer treatment are leading to more long-term remissions and potential cures, especially with the advent of immunotherapies. For instance, the CheckMate 067 study demonstrated that patients with advanced melanoma receiving a combination of nivolumab and ipilimumab had a median overall survival of about six years, with some patients remaining disease-free for over a decade. These outcomes suggest that durable responses are possible, yet the medical community remains prudent in labeling them as cures due to the potential for late recurrences.
Professor Georgina Long AO
Medical Director, Melanoma Institute Australia has recently written ‘We are now confident these patients are cured, a term not used lightly in cancer.’
A long-term study confirms that advanced melanoma patients with brain metastases can achieve long-term disease control with combination immunotherapy. The 7-year follow-up data from the ABC clinical trial, published in Lancet Oncology, shows that 51% of patients who received nivolumab and ipilimumab as first-line treatment survived long-term, compared to only 16 weeks’ survival in the past. Experts now consider some patients cured and recommend this as the standard treatment. The study highlights the impact of immunotherapy in transforming advanced melanoma into a potentially curable disease. This is an incredible message to come from one of the leaders of research into ways to treat skin cancer and the aggressive metastases that can be too often associated with it. Further research is ongoing to improve outcomes.
Conclusion
The journey through cancer diagnosis, treatment, and follow-up is fraught with emotional and medical complexities. While a decade free of disease is a monumental achievement, the medical community’s careful choice of language reflects a commitment to honesty and patient-centered care. By understanding the nuances behind terms like “cure” and “remission,” patients and their families can better navigate their experiences, maintaining hope grounded in the reality of cancer’s unpredictable nature.
