The Emperor of All Maladies - Part Three Summary
In part three of the Emperor of all Maladies, the treatment of cancer begins to shift from the previously seen extremes to being more patient centered. There is a rift in the field of surgery as surgeons such as Dr. Crile and Dr. Keynes begin to question the radical and disfiguring surgeries relied upon by an entire generation of surgeons to treat cancer. The push-back against moving away from radical surgery was so strong among surgeons, that it took many years for clinical trials to get enough patients to demonstrate the benefit of pairing less extreme surgeries with either chemotherapy or radiation. After many years, Dr. Fisher was able to demonstrate that radical surgery was no better than less invasive options which helped lead to the downfall of radical surgery.
During the same time period, the thinking around chemotherapy also underwent a similar transformation. Patients were suffering horrific side effects from chemotherapy as a result of more aggressive combinations of drugs. It was during this period that the field of palliative medicine was born, and patients finally began to receive care focused on helping them survive the side effects of chemotherapy. Doctors and scientists also began to think about cancer from a biological standpoint. A better biological understanding of breast and prostate cancer led to the introduction of hormone treatments that were fairly successful and much easier on patients. The new drugs and improved understanding of cancer led to a permanent shift in cancer treatment away from radical surgery toward individual patient focused treatment plans for specific cancer types and stages. Part three closes with a statistical debate about the best way to measure progress made in the treatment of cancer. When measuring deaths alone, it appears that despite all the treatment advances no reduction in overall deaths had been made. However, when taking into account the number of life years saved, progress has been made. This statistical debate is the jumping off point for the next section of the book, which focuses on preventing cancer.
Andi DeRogatis is a graduate student at UC Davis in the animal biology graduate group. She is currently studying how the avian immune system is influenced by the process of molt. She loves all things birds and is passionate about getting others excited about birds as well! You can follow her on Twitter @andiderogatis.
Lindsey Mooney is a graduate student in the UC Davis Psychology Department. You can follow her on Twitter @Linz_Mooney.