Advances in Cancer Treatment with Surgery For many years, surgery was the only pillar of cancer treatment (see Figure 15, p. 76). Today, it remains the foundation of curative treatment for many patients. Surgery is used in several ways during the care of a patient with cancer (see Sidebar 31, p. 79). Sometimes, additional therapy is given before, after, or around the time of surgery based on specifics of a patient’s situation (see Sidebar 32, p. 80). Researchers have found that this approach not only improves the surgeon’s ability to remove the tumor (for example by shrinking the tumor when given before the surgery), but also increases the patient’s overall survival and/or quality of life (359). Improving Quality of Life After a Cancer Surgery Despite the immense benefits of surgery for the treatment of cancer, complications are common and can negatively affect patient quality of life. Enhanced recovery after surgery (ERAS) programs are emerging as one approach to address this issue. These comprehensive programs focus on optimizing patient care before, during, and after surgery using strategies that ensure the patient is as physically and emotionally fit for surgery as possible; alleviate the stress of surgery; promote recovery; and reduce the time before patients with cancer can begin adjuvant treatment. Providing patients with an individualized plan that includes exercise, nutrition, stress reduction, and smoking cessation to optimize their physical fitness before surgery is one strategy included in some ERAS programs (360,361). The components of ERAS programs can vary depending on the type of surgery being performed and the center at which the surgery is being performed, but overall, these programs have been promising. Disparities in Clinical Trial Participation To ensure that candidate anticancer therapeutics are safe and effective for everyone who will use them if they are approved, it is vital that the participants in the clinical trials represent the diversity of the patient population. Despite this knowledge, several segments of the U.S. population are underrepresented in clinical trials. Examples of these disparities include the following: Only 15% and 20% Between 2012 and 2017, the U.S. Food and Drug Administration approved 59 novel anticancer drugs based on 64 clinical trials. Based on U.S. disease prevalence, only 15 percent of these trials adequately represented Black patients and only 20 percent adequately represented Hispanic patients (335). Less than 2% An evaluation of clinical trial participation among older adult patients with cancer from January 1, 2014, through June 30, 2020, showed less than 2 percent enrollment (336). Only 2% Black patients represented 2 percent of the patients in clinical trials conducted between January 2010 and August 2022 that led to the approval of 92 immunotherapeutics for the treatment of more than 20 cancer types (337). POORER access An evaluation of immunotherapy clinical trials for metastatic melanoma conducted in the United States between 2015 and 2021 showed that rural areas had significantly poorer access to such trials compared to urban areas (338). 0% and 2% In the clinical trial that led to the 2022 FDA approval of mirvetuximab soravtansine-gynx (Elahere) for the treatment of ovarian cancer (see Delivering a Cytotoxic Drug Precisely to Ovarian Cancer Cells, p. 86), 96 percent of participants were White, none were Black, only two percent were Hispanic and Asian, respectively (339). SIDEBAR 28 AACR Cancer Progress Report 2023 Advancing the Frontiers of Cancer Science and Medicine 74
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