The past, present and future of cancer care


There have been scores of drug approvals across the globe for treating cancer in recent years, and the right combination of treatment and patient can lead to longer, better living with the disease. With all these breakthroughs on top of years of experience in care administration, how much has the patient experience changed?


Professor David Stewart, medical oncologist and professor of medicine at the University of Ottawa and Ottawa Hospital, has compiled his decades of clinical experience, practise and research into his new book. He looks at the rate of progress in detecting and treating different cancers, what risks towards cancer can occur in life, how successful different healthcare systems are in caring for cancer patients.


A Short Primer On Why Cancer Still Sucks is available via Amazon.


Image credit: Sebra / Shutterstock




The following transcript is automatically generated


00:00:01 Will Mountford

Hello I’m will welcome to research pod.


00:00:09 Will Mountford 

In 2020, the US FDA granted 39 new or expanded approvals for cancer treatments. 


00:00:16 Will Mountford 

In the same year, there were an estimated 1.8 million new cancer cases and 600,000 deaths from the disease. 


00:00:25 Will Mountford 

Meanwhile, the NHS in the UK estimates that half of people living today will develop some form of cancer in their lifetime. 


00:00:33 Will Mountford 

These are all big numbers comprising the lives of 1,000,000 upon millions of people affected directly or indirectly by a disease originating from within their very own cells. 


00:00:45 Will Mountford 

Against that backdrop, Professor David Stewart, medical oncologist and Professor of medicine at the University of Ottawa and Ottawa Hospital, has compiled his decades of clinical experience, practise and research into the new book, Why Cancer still sucks. 


00:01:01 Will Mountford 

Today we’re talking about what it’s like for patients and families facing diagnosis, what to look out for in finding proven, effective treatments, and when, or rather if, things are going to get better. 


00:01:18 Will Mountford 

Doctor David. Hello? 


00:01:20 Dr David Stewart 

Hi, how are you? 


00:01:21 Will Mountford 

I am doing OK. Thank you very much for your time to join us. If you could start off with a little bit about you, the person behind the research, the person behind the book, what’s led to writing this book now and why it’s you writing? 


00:01:35 Dr David Stewart 

I’ve been in medical oncologist now for more than 40 years. Did my I came from Ottawa or the auto regional not in Canada originally, but did my oncology training at MD Anderson Hospital in Houston, TX and then back up here in 2011 and as head of the Division of Medical Oncology when I was head of the division until 2019. 


00:01:55 Dr David Stewart 

And I’ve just kept on as a medical oncologist and at the University of Ottawa here so. 


00:02:02 Dr David Stewart 

As far as why writing the book, I’ve been telling my wife for the last 20 years I was going to write it, but it


00:02:08 Dr David Stewart 

Was only about 2019 that I actually started to do it. 


00:02:11 Dr David Stewart 

And the reason for it is because a twofold the just the questions that my patients have when I meet with them and just to try to explain things to them.


00:02:22 Dr David Stewart 

And what they often tell me is that uncertainty is worse than bad news, and they’ve got bad news. Then they can figure out how to deal with it. 


00:02:30 Dr David Stewart 

They’ve gotten certainty that’s much worse. And so it’s just to give them a bit more education, a bit more insight into why things are the way they are and many patients find that’s helpful. 


00:02:42 Dr David Stewart 

Some of them actually find it very scary, but the majority find it very helpful. So there was one reason and the other reason for writing it is there are many systems issues that interfere with access to effective treatment. And so the other part of the book was to address systems issues. 


00:03:00 Dr David Stewart 

Identify what they were and what we might have to do to make those systems issues better. 


00:03:06 Will Mountford 

I imagine there’s lots of times that you thought actually this is quite hard work. 


00:03:10 Dr David Stewart 

I love doing this because of what I can do to help patients and also just the interest, the the fact that things are are progressing so rapidly makes it extremely exciting and extremely challenging. 


00:03:23 Dr David Stewart 

And so the name of the book is a short primer on why cancer still sucks. Essentially, it can be obtained online through Amazon Books. 


00:03:32 Dr David Stewart 

Or on my website to why either? It can be obtained through through either of those sources, and Amazon will typically ship it to just a few days after ordering it so so it can be available quite rapidly. 


00:03:46 Dr David Stewart 

And essentially it’s designed to try to cover the the entire front of cancer. Like, why is it so common? 


00:03:53 Dr David Stewart 

What are the benefits and limitations of screening how cancer causes symptoms? What are the treatment options? What things slow us down as far as the NES and Legends that interfere with? 


00:04:04 Dr David Stewart 

Progress and then the systems issues. So, So what is the impact of it taking so long to develop new drugs? 


00:04:10 Dr David Stewart 

What are the factors that are responsible for those speed bumps that to the slow us down? What makes the new therapies so expensive? 


00:04:18 Dr David Stewart 

Why are they so expensive and what can we do to reduce that? And then I do a comparison of the Canadian health. 


00:04:24 Dr David Stewart 

And US health care systems and what the strengths are, what weaknesses are. At the end of that chapter, my conclusion is that I love them both and I hate them both. They both have major issues, but they also have major strengths. 


00:04:36 Dr David Stewart 

And then the final. 


00:04:36 Dr David Stewart 

Chapter is where the where the future is going to align. Why? By a few years from now, things will be much different than they are now because things have have changed rapidly. 


00:04:46 Dr David Stewart 

Things are going to cheat, keep on changing rapidly. So at time of great hope, in a time of great to progress, at the same time, it’s the time of great challenges. So each chapter is. 


00:04:56 Dr David Stewart 

Actually set up with two sections. So one section is a short primer section that’s written in lay terms so that anybody with a non medical background can understand it and then it’s followed by a further detail section that I go into a bit more depth for the people. 


00:05:13 Dr David Stewart 

That are interested in more depth. 


00:05:14 Dr David Stewart 

And it gives references and things like that, so a bit more technical so that people can get both sides of it. 


00:05:20 Dr David Stewart 

But there are some people that prefer just read the short primary section because that gives the the basics and try to make sure that it can be understood by people in non medical the two major people that edited the. 


00:05:33 Dr David Stewart 

Book for me. 


00:05:34 Dr David Stewart 

Was my wife, who’s an interior decorator, and my stepdaughter, who’s an elementary school teacher so. 


00:05:40 Dr David Stewart 

I had to make sure. 


00:05:41 Dr David Stewart 

They they pointed out any place that was getting too technical and so that was very helpful to me to make trying to make sure that that people that were non medical could understand it. 


00:05:54 Dr David Stewart 

So cancer is cells growing that should not be growing like ordinarily . Cell growth is is happening all the time, but it’s very tightly regulated. 


00:06:04 Dr David Stewart 


Things only start dividing. Cells only start dividing when they’re supposed to, and they stop dividing when they’re supposed to. And in cancer, that regulation is gone, so they keep on growing. 


00:06:14 Dr David Stewart 

And that has major consequences for the for the body just putting in pressure on surrounding structures and make them not to not work using up put lots of energy and things like that. 


00:06:26 Dr David Stewart 

And it can actually occur, cancer coming to start in any part of the body, but there are some parts that are it’s much more likely to start than others, particularly tissues that to grow a lot. 


00:06:36 Dr David Stewart 

So that in our body cells are constantly being replaced as so and non-stop and it’s so any any tissue that cells don’t divide very frequently will be less. 


00:06:46 Dr David Stewart 

Likely to get cancer. Any that they divide more frequently, more likely but apart almost any part of the body cancer can develop, but the common ones are things like lung cancer and breast cancer and colon cancer and prostate cancer and things like that. But there it can occur anywhere. 


00:07:02 Dr David Stewart 

The reason it. 


00:07:03 Dr David Stewart 

Happens the the number one risk to in getting cancer is to just get older, because all of us have an average about 37 trillion cells around body. 


00:07:15 Dr David Stewart 

An average of about 100 billion of them divide every day. Just to replace old cells. 


00:07:19 Dr David Stewart 

That are being damaged or are no longer functional. 


00:07:22 Dr David Stewart 

And for each of those 100 billion cells that divide, there’s an average of 3/3 mutations per cell that divides. 


00:07:29 Dr David Stewart 

So every one of us has an average of 300 billion new mutations in our body every day. 


00:07:35 Dr David Stewart 

Which is a huge number. So most, maybe most of them are not important, because either they’ll be repaired or they will not cause any major change in function, or they will make the the cell commit suicide and die, or the cell will become what we call senescent. So they’re they’re old, they just sit there, they can no longer divide so. 


00:07:55 Dr David Stewart 

They cannot pass on the mutation to other cells, but they’re also and so they can still function, but they’re not dividing anymore. 


00:08:02 Dr David Stewart 

So the the good news is it takes 10 to 20 mutations and one cell for it to become a cancer cell if it only. 


00:08:08 Dr David Stewart 

Took one, we’ve. 


00:08:09 Dr David Stewart 

All developed cancer at a very, very early age. 


00:08:12 Dr David Stewart 

Because every time we have another meal, we’re causing some new mutations. Every time we take another breath or cause some new mutations. 


00:08:19 Dr David Stewart 

And so that it’s the fact that as 10 to 20 mutations at any given themselves. That’s why that most people do not develop cancer until they’re older, but it also is why the older somebody is, the higher the risk of. 


00:08:32 Dr David Stewart 

Getting cancer because it just gives time to accumulate the number of mutations that are needed to cause cancer. 


00:08:38 Dr David Stewart 

But the things that will increase the risk of developing cancer are anything that will increase the number of mutations in the cell, anything that causes cell damage. 


00:08:46 Dr David Stewart 

So things like cigarette smoking or excess sun exposure or processed meats or air pollution or radiation exposure, a whole bunch of different things like that. So that’s one thing that can do it. 


00:08:58 Dr David Stewart 

And the other thing that does is at anything that increases the number of cells defining the rate of cell division. 


00:09:04 Dr David Stewart 

So just getting too many calories and being overweight can do it, being exposed to hormones that drive cell division. 


00:09:13 Dr David Stewart 

All of those things can do it just by increasing number of mutations, by increasing number of cell divisions. So the number one way to reduce risk is to reduce the risk of exposure to those things. 


00:09:25 Dr David Stewart 

So actually, so it was here, though having my wife review it was very helpful because she kept on reminding me that we all needed to have a good time in life and so. 


00:09:32 Dr David Stewart 

It’s not to eradicate. 


00:09:34 Dr David Stewart 

All the things that can cause it, but to limit the quantity like alcohol which is another important one that increases that. 


00:09:40 Dr David Stewart 

Risk to limit exposure rather than trying to tie yourself up in a bubble where we’re not exposed to anything but that just helps them reduce risk and get through life with enjoying it but with not quite as high at risk of getting cancer. 


00:09:55 Will Mountford 

Now, you mentioned that mutations can lead to cancer with excess cell division, but they can also lead to. 


00:10:01 Will Mountford 

The pausing of the cell cycle or destruction of the cell. So if that is the disease, is that it’s not a cell that is stopped from dividing or cell that is killed. How can we get that cancer to stop dividing or kill those cells? 


00:10:14 Dr David Stewart 

That’s right. So the. 


00:10:15 Dr David Stewart 

Number one way is if the cancer is already established, to remove it by surgery. To get rid of it is very important. 


00:10:22 Dr David Stewart 

And that can cure cancers, although it may not so that anybody with cancer. There are millions of tumour cells circulating the bloodstream that have been shed from the cancer, but many of them are sick and they die, and that’s why cancers. 


00:10:34 Dr David Stewart 

Can be cured, but if any of them were able to lodge and survive in other areas. 


00:10:38 Dr David Stewart 

Then after the cancer is removed by surgery, then those will start going later as metastasis and that will make the cancer incurable because you cannot remove them all. 


00:10:47 Dr David Stewart 

So that’s one way to do it though is by a surgery and others radiation. So radiation damages the genetic material in cells and again normal cells can repair a lot of that. 


00:10:59 Dr David Stewart 

Cancer cells also can’t, but the techniques that are used in radiotherapy increase the probability that then it will kill cancer cells over normal cells. 


00:11:07 Dr David Stewart 

And so that by doing that, some cancers that cannot be cured by surgery may be cured by radiation. Or if the cancer is always spread and is causing symptoms, then the radiation can shrink the cancer in some cases and improve symptoms, even if it cannot cure the cancer, if we move on to when the cancer is more advanced, if it’s already widespread. 


00:11:28 Dr David Stewart 

It cannot. Right? 


00:11:29 Dr David Stewart 

Then what are called systemic therapies are used and they’re called systemic therapies because they go through the bloodstream and they go everywhere in the body and they may be able to kill cancer cells, shrink cancers and improve life expectancy and improve symptoms and improve quality of life. So the first one of the early types of systemic therapies was chemotherapy. Again, it. 


00:11:49 Dr David Stewart 

Damages the DNA or other parts of the cell, so it actually can thereby kill. 


00:11:55 Dr David Stewart 

Well, and the only chemotherapy drugs are useful are ones that are more effective at killing cancer cells that are killing normal cells and his whole variety of reasons why they might have a preferential activity against against cancer cells. 


00:12:08 Dr David Stewart 

But in most cases they cannot cure the cancer, although there are some very specific examples where they can’t. So some acute leukemias and lymphomas. 


00:12:16 Dr David Stewart 

Chemotherapy can actually cure. They can eradicate it completely metastatic testicular cancer. There are many patients that that can be cured with chemotherapy or what are called gestational cardio carcinomas, which is essentially a malignant pregnancy. Many of those can be cured by it by chemo. 


00:12:31 Dr David Stewart 

Yeah, but the common cancers like breast cancer, colon cancer, lung cancer, etc cannot be when the widespread we may be able to improve the transfer, cure the cancer being moved by surgery just by eradicating the very small tumour deposits in other parts of the body. 


00:12:45 Dr David Stewart 

Or we may be able to make regular therapy work better with chemotherapy, but we usually cannot cure the cancer with. 


00:12:51 Dr David Stewart 

Widespread but can’t the chemotherapy can prolong life expectancy, can prolong and improve the quality of life because the improvement in symptoms from the cancer outweighs the side effects in the average patient, so it can be beneficial. 


00:13:06 Dr David Stewart 

The other way to do it with systemic therapies of hormonal therapies, so, so that cancers that are driven by hormones in the body like some breast cancers, some prostate cancers, if we interrupt that that those hormones then we can get the cancers to shrink and again so this can be very effective, so metastatic widespread breast cancer. 


00:13:26 Dr David Stewart 

For example, drugs like tamoxifen and the aromatize inhibitors can be quite quite. 


00:13:32 Dr David Stewart 

Active and for prostate cancer anti androgen sends it to antagonise the testosterone to make them shrinking could be quite valuable. 


00:13:41 Dr David Stewart 

And then the other new class of drugs that came along about 20 years ago were the targeted therapies as mutations occur in cells that results in the production of abnormal proteins that are. 


00:13:52 Dr David Stewart 

Driving the cell growth and these targeted therapies specifically block those those abnormal proteins. 


00:13:58 Dr David Stewart 

And so that the targeted therapies also their evolution also led to the whole field of personalised therapies. Our precision medicine, because it’s only the person has a very specific mutation that these drugs will work, but they will work much better than chemotherapy at that mutation is is present so that. 


00:14:18 Dr David Stewart 

And now for example, a patient with that. 


00:14:20 Dr David Stewart 

Lung cancer who has a Ros 1 fusion gene. I can use a drug that is much more effective than chemotherapy, but it’s only 1% of patients that I can use in him. 


00:14:30 Dr David Stewart 

So then we have to do a very specific molecular testing looking for presence of these mutations before we start treatment, because these mutations are there, we’ll be able to. 


00:14:39 Dr David Stewart 

Come up with much better. 


00:14:40 Dr David Stewart 

Treatment and then just treated with chemotherapy where the mutation isn’t there, then the targeted therapy won’t work. 


00:14:45 Dr David Stewart 

At all. 


00:14:46 Dr David Stewart 

The other part. 


00:14:47 Dr David Stewart 

Of systemic therapy is immunotherapy, things to unleash the immune system against cancer. 


00:14:53 Dr David Stewart 

And back when I first started my my oncology training back in 1976, it was thought that immunotherapy was put to cure all cancers. 


00:15:02 Dr David Stewart 

But the problem is that was a huge amount of hype and hyperbole and very little things that actually worked. And so I I became quite disillusioned with immunotherapy and I used to tell the trainees that immunotherapy. 


00:15:14 Dr David Stewart 

Been about to cure cancer for the past 50 years, but then something radical happened in about 2014. Two thousand. 


00:15:21 Dr David Stewart 

Deep. And that was the checkpoint therapies, the PD1, PDL 1 inhibitors that suddenly could turn on the immune system and were highly effective in some patients. 


00:15:32 Dr David Stewart 

So they worked in about 10 to 20% of patients with a wide range of cancers and they could have worked much better than chemotherapy in those 10 to 20% of patients, but again. 


00:15:41 Dr David Stewart 

And people and other places where they didn’t work, it was like giving a patient placebo. So we could not predict who was going they were going to work in, but there could be a mark benefit and those 10 to 20. 


00:15:51 Dr David Stewart 

Yeah, it’s like you want to get more power into your house to turn on the lights. You keep more loading, more and more power into the power lines, but nothing happens. 


00:15:59 Dr David Stewart 

And that was the early days of the immunotherapy people trying to load more and more power, new power lines and nothing happening. 


00:16:05 Dr David Stewart 

And then somebody just comes along, flips a switch, and all the lights come on. And that’s what these drugs do. They flip the switch to. 


00:16:11 Dr David Stewart 

Be able to turn on the immune system. 


00:16:13 Dr David Stewart 

And we’re we’re rapidly learning more and more about why they don’t work when they don’t, when they do. 


00:16:17 Dr David Stewart 

Not work and. 


00:16:18 Dr David Stewart 

Finding other new ways of of doing this. 


00:16:21 Dr David Stewart 

So this is something that could have a very profound impact. It always has a very profound impact. This class of drugs, the immune checkpoint inhibitors have been effective against a broader range of cancer than any new therapies. 


00:16:33 Dr David Stewart 

That they’ve come along since the drugs is platinum back in the 1970s. So this had a major impact on cancer and there’s reason to believe that it could get better and better. 


00:16:48 Will Mountford 

As your book covers, the surgery, radiotherapy and targeted therapies have been quite a bit of depth through chapters 3 through 7. 


00:16:55 Will Mountford 

I’m going to skip ahead to Chapter 11 and ask you a question about the cost effectiveness of our treatments ’cause. You mentioned targeted therapies and immuno therapies there towards the. 


00:17:04 Will Mountford 

And and whilst they are like you say, having some very profound effects for some people, how is that cost being matched against the actual life years that people gain? 


00:17:15 Will Mountford 

Because if we are spending hundreds and thousands of pounds on years and years of treatments, then are people getting, well, years and years of benefit? 


00:17:24 Will Mountford 

Out of that. 


00:17:25 Dr David Stewart 

This is very, very important is the cost in both toxicity and also the dollar costs and the the cost of the medications has escalated rapidly over the over the past several years and this is because the major driving factor is just the cost of new drug development. There’s a bigger cost to not getting the medications. 


00:17:46 Dr David Stewart 

Because these drugs do prolong useful life and also alleviate suffering, then if as if there’s delays in carrying them, then there are thousands upon thousands of life years lost. One life here is one person being alive one year. 


00:17:59 Dr David Stewart 

So thousands of life years lost while there’s delays and also suffering. 


00:18:04 Dr David Stewart 

That it did. 


00:18:05 Dr David Stewart 

Not have to happen because these drugs would have would have improved the suffering. 


00:18:09 Dr David Stewart 

One of the things that most governments do when they consider bringing these drugs, often in patients, is looking at the cost of her life, quality adjusted. 


00:18:18 Dr David Stewart 

Life years so. 


00:18:19 Dr David Stewart 

They look at that in deciding whether they should bring the drugs on and what the how much they should pay for them. This is good, but it’s also problematic because those negotiations. 


00:18:28 Dr David Stewart 

It’s also slow access to these drugs after the the drug has already been approved by the the licencing agencies. 


00:18:36 Dr David Stewart 

It may take a long time before most patients can access it, so this is a big problem because in the old days, many years ago, we would all pay for treatment of her own pocket and we make the decision whether it was worth it or not. 


00:18:49 Dr David Stewart 

Now it’s somebody else is making that decision and this is a big problem, just there’s somebody else making the decision, but we can’t escape it because of the high cost. 


00:18:58 Dr David Stewart 

Most people would not be able to pay the. 


00:18:59 Dr David Stewart 

Costs themselves but. 


00:19:00 Dr David Stewart 

There are things that we can do to bring down the costs while improving access. 


00:19:05 Will Mountford 

Add a circle back to some of the earlier chapters in the book. There’s something that I think is very important to discuss and the non clinical offerings of cancer cures or solutions to disease is very important and it’s something that means a lot to a lot of people facing a very big threat to their life. So why people are either vulnerable? 


00:19:25 Will Mountford 

To this non medical exploitation or why people are doing it. 


00:19:29 Will Mountford 

To them. 


00:19:30 Dr David Stewart 

Yeah, so they. 


00:19:31 Dr David Stewart 

You’re very right that patients are desperate and so I they come to see me and I tell them that cancer is not curable. 


00:19:38 Dr David Stewart 

And their average life expectancy without chemotherapy is four months and with chemotherapy about a year. 


00:19:42 Dr David Stewart 

And 1/2 and then. 


00:19:44 Dr David Stewart 

Their neighbour tells them about how they cured themselves just by drinking water from the Regal River. People are desperate, so they will. 


00:19:50 Dr David Stewart 

Listen to these. 


00:19:51 Dr David Stewart 

Things, although many patients understand also that this this issue, and I’ve also I’ve often told people that if you want to make $1,000,000 you just write a book about how you can cure cancer by just doing Tai chi or things like that or. 


00:20:04 Dr David Stewart 

That people are very vulnerable, so as far as the alternative therapies are concerned, their alternative, because there is no proof that. 


00:20:11 Dr David Stewart 

They are benefiting. 


00:20:13 Dr David Stewart 

That doesn’t mean that they that none of them ever will be of benefit, but that the claims are being made for them are not substantiated. 


00:20:20 Dr David Stewart 

And if any of them. 


00:20:21 Dr David Stewart 

Were found to be valuable, then we would unequivocally. 


00:20:24 Dr David Stewart 

And or some just like we tell patients to eat diets or rich in fruits and vegetables, we tell, but many patients get lots of exercise. 


00:20:30 Dr David Stewart 

Patients with heart attacks or strokes would tell them to take logos, aspirin, cheap logos, aspirin daily. If those same things were available for cancer, we would unequivocally make use of that and use it. 


00:20:43 Dr David Stewart 

But the things that we do not endorse is because the proof is not there. Often there’s a good logic to it, or it sounds like. 


00:20:50 Dr David Stewart 

Big logic, but it just doesn’t hold together or end it. It just doesn’t that there’s just not. 


00:20:56 Dr David Stewart 

In there. And so again, some people, it’s just well, well meaning people that are doing this, but some are also making a fortune. 


00:21:03 Dr David Stewart 

Like, I had one patient that she can’t. She came to me and I told her that despite treatment, cancer is still calling. And she’s kind of said it can’t possibly be calling my marijuana dealer. He’s giving me $800 worth of marijuana. 


00:21:16 Dr David Stewart 

A week and he told me that he will cure my cancer for certain. So this is a problem when people are being sold things that is making somebody else rich, but they’re desperate and is giving them false hope. This is not good. 


00:21:28 Dr David Stewart 

The other thing that we run into is that patients will tell their story and they will convince everybody else that they cured themselves. 


00:21:34 Dr David Stewart 

So number one woman, not talking to her at a party, she said that she cured herself of cancer and ask her what kind of cancer? 


00:21:41 Dr David Stewart 

And she said, well, I’m not sure. Well, why did they bother? Well, they didn’t do a biopsy, but when they did, the stands words cancer. Well, they didn’t do a scam, but I just knew I had cancer. 


00:21:48 Dr David Stewart 

Because of the way I felt and so I cured it by. 


00:21:51 Dr David Stewart 

Taking these drugs. 


00:21:53 Dr David Stewart 

So that’s one brand. But another person who was working at our condo convinced my wife that he cured himself with alternative therapy. 


00:22:00 Dr David Stewart 

So my wife told me. I told me that I should expand my horizons by talking to him. So I did. 


00:22:05 Dr David Stewart 

I saw I had a careful conversation with him. He really had cancer. It was one that’s highly curable by radiotherapy and had high dose radiation. 


00:22:12 Dr David Stewart 

But he took this alternative therapy, so he told all his friends that he cured it by the alternative therapy. 


00:22:17 Dr David Stewart 

And he forgot to mention that he also had a treatment that would. 


00:22:20 Dr David Stewart 

Have a high probability. 


00:22:22 Dr David Stewart 

Of curing it without the alternative therapy. So what these things do? 


00:22:27 Dr David Stewart 

So they make. 


00:22:28 Dr David Stewart 

Somebody the centre of attention and make a good story, but the problem is that they induce other people to in desperation and do things that are not going to to help them. 


00:22:39 Dr David Stewart 

So of all the alternative therapies out there, could anything work possibly because like many of our chemotherapy drugs came from plants originally? 


00:22:47 Dr David Stewart 

And some of them are plant products, so they might work, but there’s just no nothing to say that. 


00:22:52 Dr David Stewart 

They are working. 


00:22:53 Dr David Stewart 

So it’s all. 


00:22:54 Dr David Stewart 

Just claimed without any proof and we really need the the proof that they are working to incorporate them into standard practise. 


00:23:03 Will Mountford 

Well, I think it’s also worth considering, as you do in some of the later chapters of your book, the structural means through which people become desperate enough to either seek alternative solutions or become vulnerable to their influence. 


00:23:15 Will Mountford 

And you mentioned at the start of the interview that you examine the American and Canadian healthcare systems and find the advantages and disadvantages of both. 


00:23:24 Will Mountford 

So I think it’s worth always taking the time to reflect on what the barriers at two people receiving adequate care are or being in a position. 


00:23:31 Will Mountford 

To accept the care that is made available to them. What the shortcomings in that care are either if it’s affordability, time, access, the people, the support around them or the physical location if they can get to where, I don’t know, linear accelerator for proton therapy is so we’re not just victim blaming people here. 


00:23:49 Dr David Stewart 

So I mean, one of the things with access again is new drugs, the fact that it takes. 


00:23:55 Dr David Stewart 

An average of 12. 


00:23:55 Dr David Stewart 

Years to bring an effect, a new drug from discovery to more. 


00:23:59 Dr David Stewart 

2nd and these are drugs that can prolong life and alleviate suffering. So that’s a long time. The thing that that’s driving that long time interval, which is much longer now than it was 30 years ago, is regulation and deregulation is absolutely essential because clinical research and there’s lots of ways that things can go along. So the regulation is essential. 


00:24:19 Dr David Stewart 

But we need much smarter regulation to do this, and we know we can do it because COVID, it only took a year to come up with effective vaccines for COVID and 12 years to come up with an effective drug for, for, for cancer. And it’s all driven by how the how it’s regular. 


00:24:35 Dr David Stewart 

And so I use the. 


00:24:35 Dr David Stewart 

Analogy in the book of the Germany Autobahn, where it’s. 


00:24:39 Dr David Stewart 

Got unlimited speed limits. 


00:24:40 Dr David Stewart 

But Despite that, has one of lowest traffic fatality rates in Europe. 


00:24:44 Dr David Stewart 

And it does that by smart regulation. And so we need our regulation to be much smarter so that it permits rapid progress, just like it did with COVID vaccines, but well. 


00:24:54 Dr David Stewart 

Also maintaining safety and data integrity and and things like that. 


00:24:58 Dr David Stewart 

So we need that. 


00:24:59 Dr David Stewart 

Then once the drug is approved, then drug funding. 


00:25:03 Dr David Stewart 

So for the United States, for example, then once it’s proved by the FDA, it’s almost instant that’s available to patients. 


00:25:11 Dr David Stewart 

’cause, the FDA and the American government have deal with drug companies that whatever the drug company is going to charge, they’ll pay it and they’ll get immediate access. 


00:25:19 Dr David Stewart 

In the Canada and Europe and other countries, there are a long process is to then figure out who’s going to pay for it and how. And that happens fastest in countries like Germany. 


00:25:32 Dr David Stewart 

Excellent. It takes much longer in Canada and New Zealand and Portugal for that to happen. And again, if people cannot access it to add these drugs because there’s nobody paying for them, then again, that’s thousands of life, years lost and thousands of people are suffering because they that do not. We would not have to suffer if they had access to these. 


00:25:51 Dr David Stewart 

Drugs. So we’ve got a. 


00:25:52 Dr David Stewart 

Huge problem in Canada in particular, but also New Zealand and some other countries who just figuring out what the funding process should be to get these drugs fund faster. 


00:26:03 Dr David Stewart 

And it’s not as if it can’t be done, because if Germany can do it, count it can do it. If the UK can do it, then Canada can do it, but we’re not. 


00:26:10 Dr David Stewart 

And so this is a major, major problem and and it actually so in fact in Canada if you’ve got private insurance then you can get access as soon as hell can’t approve them. 


00:26:19 Dr David Stewart 

But then takes another year and a. 


00:26:20 Dr David Stewart 

Half to get the. 


00:26:21 Dr David Stewart 

Public funding and who has private insurance. Many of the people that are doing the negotiating on behalf of government have private insurance. 


00:26:29 Dr David Stewart 

So they get. 


00:26:29 Dr David Stewart 

Access immediately, but the people they’re negotiating on, on behalf of do not get to access until they’ve finished their negotiation, so this is a problem. 


00:26:38 Dr David Stewart 

The other thing also is that just the time from the suspicion of a cancer until the documentation of cancer, the staging all the diagnostic things, the molecular testing, etc. 


00:26:50 Dr David Stewart 

There are delays during that time period before treatment can be started, and for some cancers that are localised or potentially curable, the probability of dying from the cancer. 


00:26:58 Dr David Stewart 

Goes up by more than 1% per week up delay in getting getting the treatment started or if you’ve got a metastatic cancer for metastatic non small cell lung cancer. 


00:27:07 Dr David Stewart 

Sample then for every week of delay and getting the treatment started, 4% of remaining patients die during each remaining week, and many others become too sick to even think of undergoing treatment so that this is important to get. New things happen very, very rapidly, but in Canada it takes too long because we’ve got fewer. 


00:27:27 Dr David Stewart 

Cats counters per million population than Turkey or Greece or any of many of the Eastern European countries. We’ve got very few hospital beds compared to other countries. We’ve got to fewer specialists per million population in most other countries. 


00:27:40 Dr David Stewart 

So in Canada, it takes too long to just. 


00:27:42 Dr David Stewart 

Get all the. 


00:27:43 Dr David Stewart 

Upfront testing done and to get to the treatments started. 


00:27:47 Dr David Stewart 

And so this is this is very, very important but but across all countries it takes longer than than we would like to see it take but there’s some countries that it takes, it takes longer than others and so that’s so access. 


00:28:00 Dr David Stewart 

It is a major problem. So when I discuss the the difference between the Canadian American healthcare system for example. 


00:28:07 Dr David Stewart 

I point out that the probability of surviving a cancer is about 67% of all Americans that will survive cancer. 


00:28:15 Dr David Stewart 

We look at all cancers compared to about 62% of Canadians or 63% Canadians. So that 4% difference does. 


00:28:21 Dr David Stewart 

Not look large. 


00:28:22 Dr David Stewart 

But that’s been consistent over many years and if you look at the number of patients. 


00:28:26 Dr David Stewart 

Canadians die of cancer if that that 4% extra death rate was not there. That would mean about 9000 fewer deaths from cancer across Canada if the average Canadian just had the same access as the average American. 


00:28:39 Dr David Stewart 

On the other hand, there are other things that Canada does much better. So that the reason that for the United States, despite despite having the most expensive health care system, the reason that their average life expectancy they ranked 46 just to have it of Albania is because they’ve got a problem with providing access to young people because young people are often not insured. 


00:29:00 Dr David Stewart 

And if a young person dies or something that they could they could have been saved from, that is much greater impact on your average life expectancy than if an older person dies. And also the and the. 


00:29:10 Dr David Stewart 

United States, and because of the lack of access of the young people, they’ve got one of the highest maternal death rates and one of the highest infant death rates in the Western world. And and this is very bad that this happens. 


00:29:23 Dr David Stewart 

And also, there’s other things outside the health care system that also increase the probability of young Americans dying. And so the deaths from drug overdose is much higher United States and in Canada. 


00:29:34 Dr David Stewart 

That’s from traffic accidents much higher in the United States and Canada. Death from homicides in about 5 times higher in the United States and Canada. 


00:29:41 Dr David Stewart 

And also, being in prison will take an average of five years off your life expectancy, and American is 6 times more likely to be in prison than a Canadian. 


00:29:50 Dr David Stewart 

So that these are things outside the healthcare system that have a major negative impact United States that are not compared to Canada. So I would love to have Canadians have the same. 


00:30:02 Dr David Stewart 

Rapid access to diagnosis and treatment for cancer as Americans, but many other things in health care system I prefer to see the way it’s done in Canada. 


00:30:11 Will Mountford 

Well, on a hopefully optimistic note, the last chapter of the book, Chapter 15, is looking at the future of cancer care cure, kind of the onset and aetiology of. 


00:30:21 Will Mountford 

It is there anything that you do see as a hopeful development in the near future for cancer care or in changes to society access and equity in healthcare? 


00:30:31 Will Mountford 

Provision perhaps? 


00:30:33 Dr David Stewart 

Yeah, so so. 


00:30:34 Dr David Stewart 

What I point out in the book is that my mentor, that the head of our department when I went down to MD Anderson Hospital in Houston for training, his name was M OJ Freeway and he was one of the most brilliant people that I’ve ever met. 


00:30:46 Dr David Stewart 

But he had fireworks laws and private one of fabrics laws was the only people who come close to predicting the future are the science fiction writers. 


00:30:53 Dr David Stewart 

And they always underpredict rather than over protecting. And the time that we told us that manifest for whatever thought we’d be walking around with phones in our pocket, but we would no longer need a map because they, uh, computer on car would be talking to the satellite. And yet all these. 


00:31:05 Dr David Stewart 

Things happened very. 


00:31:06 Dr David Stewart 

In a very short period of time. 


00:31:08 Dr David Stewart 

And and things are happening very, very rapidly. So there’s been a very rapid progress in a number of new drugs available and just a concept about what we can do for this. 


00:31:18 Dr David Stewart 

So that, as I said, I think that immunotherapy. 


00:31:21 Dr David Stewart 

And we’re that we have the potential to make. 


00:31:24 Dr David Stewart 

Huge advances for screening for cancer. 


00:31:26 Dr David Stewart 

Like right now. Mammography. 


00:31:28 Dr David Stewart 

They called off the intensive that they certainly improve the probability of being cured of cancer or not dying from the cancer, but in the future is going to be a blood test that will pick up things when they’re very early and much earlier than the current screening methods. So that’s going to be the future. 


00:31:43 Dr David Stewart 

Right now for why we give agement treatments of chemotherapy and people have undergone surgery to reduce the risk of the cash coming back again in the future. That it’ll be much different will do a blood test to see whether any circulating tumour cells that are still left after the surgery. 


00:31:58 Dr David Stewart 

If there are, that means that their tumour deposits in different parts of the. 


00:32:01 Dr David Stewart 

Body so those people will will treat. 


00:32:03 Dr David Stewart 

For minimal residual disease, whereas if there are no original cache results, it will be a very high probability that patients although already cured and we will not have to give them any further treatment for the cancer, we can just watch them. 


00:32:16 Dr David Stewart 

So those types of things in the future, I’m coming back to immuno therapies, so that there’s a new class of immunotherapy drugs called bispecific T cell engagers which is monoclonal antibody that one arm attaches to a tumour cell, the other arm attaches to a T lymphocyte which is part of the immune system brings them close together, so the T lymphocyte. 


00:32:36 Dr David Stewart 

Can destroy the tumour cell. 


00:32:37 Dr David Stewart 

I see for foresee the future that these will be customised drugs that will be made on the spot for you, where it will depend on what your tumour cells have on it that will make this bispecific T cell engager stick to it. 


00:32:50 Dr David Stewart 

So instead of it being one drug development to help a million people, it will be a new drug that’s made right then and there for you. That is very specific. 


00:32:58 Dr David Stewart 

To your tumour. So all the technology currently exists to do these types of things and if we can imagine it then we can do it. It’s going to take time. It’s going to take maybe, maybe decade. 


00:33:08 Dr David Stewart 

Kids yeah, but these types of things are things that could. 


00:33:11 Dr David Stewart 

Very well be coming in. 


00:33:13 Dr David Stewart 

The future as far as the the whole access thing. 


00:33:16 Dr David Stewart 

So I point out the bug that many things are tracked by I’ve driven by tipping points and eventually we will come to the conclusion that things are just not, not, not right in how we’re developing drugs now. It takes much too long. 


00:33:29 Dr David Stewart 

And much. It takes much too long to fund them. It takes much too long for die. 


00:33:32 Dr David Stewart 

And also, these are tipping points that once we reach them, we can do something about these things. And in fact, if we intercede early in the disease, it may be much cheaper than waiting until it’s late and then interceding later. 


00:33:46 Dr David Stewart 

And so this is the mind shift that we provide a gap where right now we look at term therapies and and tests and things like that. 


00:33:52 Dr David Stewart 

Being at being expensive, but the alternative is much more expensive that not finding things when they’re early, not offering treatments so early on. This is a much more that’s much more expensive than having effective treatments. 


00:34:06 Dr David Stewart 

Available early on. 


00:34:11 Dr David Stewart 

So we are in much different place now than we were 46 years ago when they started my oncology training, much different. 


00:34:18 Dr David Stewart 

We’ve made huge progress but we can’t. We still have a long piece to go but we are going to keep on making progress so there is hope that things are. 


00:34:26 Dr David Stewart 

Rapidly getting better. 


00:34:27 Dr David Stewart 

They’re going to keep on rapidly getting better. 


00:34:29 Dr David Stewart 

And so that’s. 


00:34:30 Dr David Stewart 

The important thing and everything we can. 


00:34:32 Dr David Stewart 

Do to speed that up is going to be beneficial. 


00:34:34 Dr David Stewart 

So that’s where chapters about 11121314 come in. How do we make it and make these things much better, much faster? 


00:34:42 Dr David Stewart 

And what? Well, what I tell all my patients with cancer, if you’ve got cancer, just tell them all. They have to be prepared for the fact that things could go badly very quickly or there’s also possibly they could be doing great. 


00:34:51 Dr David Stewart 

Years from now. 


00:34:52 Dr David Stewart 

They just just can’t predict. All it can do is take it day by day and and touch along. And I also tell my patients that optimism does not make treatments work any better, but it makes quality of life a lot. 


00:35:02 Dr David Stewart 

Better, so you might as well be optimistic as far as the book is concerned. Again, you can add the name of the book by cashier’s. 


00:35:08 Dr David Stewart 

Sucks. A short primer. White cancer still sucks, and available through Amazon Books and a whole bunch of other websites so that through other groups that sell books. 


00:35:18 Dr David Stewart 

And we’re also through my website and that has a link to a number of different people that are selling it so that the proceeds from the book. 


00:35:29 Dr David Stewart 

If I ever make a profit on, I’m going to have to sell about 3000 copies of it to make any profit. 


00:35:34 Dr David Stewart 

But if I ever do, then some of those profits are going to be shared with groups like the Lifesaving therapies network, Lung Cancer Canada, Canadian Cancer Society and other people. If they agree to accept something, I share the. 


00:35:46 Dr David Stewart 

Profits from the book. 

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