Oncology and medical writers

Abstract

Let me start this first editorial in an old journal with a new name by explaining why a medical writing journal has a theme issue on oncology and includes articles that are not directly related to writing. Medical writers write about research that is aimed at preventing, diagnosing or treating a medical disorder. They might receive an assignment that involves a disorder they know little about and need to gain an understanding of the literature on the disorder and its treatment in a very short time to meet a deadline. Quite apart from this, flexibility, curiosity, and a zeal for learning are typical characteristics of medical writers. The fund of articles in this issue cover the gamut from the nature of cancer, its current and developing therapies, management of the disease, educating healthcare workers about treatment, and communicating with patients – to tips for writing clinical trial reports. The first known written account of the disease was a description of breast cancer in the Egyptian ‘Edwin Smith’ papyrus from 3000 BC. The cut surface of a solid malignant tumour with veins stretched on all sides is like a crab with its feet on all sides of the body, hence the name ‘cancer’ which comes from the Greek word carcinos, meaning crab. The vocabulary we use for cancer is loaded with metaphors, mostly taken from military quarters. We are ‘at war’ with and ‘fight’ cancer, which reflects its devastating effects and urgent need of treatment. The military metaphors also help to rationalize the radical treatments required. Cancer encompasses many diseases and has a reputation for being a complex and deadly disease even though about one-third of cases are non-melanoma skin cancers, which are easily treated and usually cured, although they are excluded from cancer statistics precisely for this reason. In her article ‘The war on cancer’ (p. 8) Jo Whelan, a medical journalist, summarizes current thinking on what makes cancer cancer, the question first posed by Hanahan and Weinberg in 2000. She explains how the hallmarks of cancer that they outlined then, and added to in a 2011 update, have had a tremendous influence on scientific opinion and research although they have not been without their critics. The symptoms of cancer are not immediately evident and few are specific, which means that when they come to light they are often confused with symptoms of other disease, leading to inappropriate treatment. Once detected, cancer is diagnosed by examination of a tissue sample by a pathologist. This work could be taken over by computers in future. In a recent report in Science Translational Medicine, Daphne Koller and colleagues describe a program (C-Path) that they have produced by scanning images of slides and survival data from 248 breast-cancer patients. With this information the program was able to grade the slides from other patients and predict whether the patients would survive for 5 years after treatment, a prediction that pathologists have not been able to make. The implications are profound not only for diagnosis, but also for ethics, because as the costs of cancer therapy increase and budgets become tighter more information will be available on which to base decisions as to who does and does not receive treatment. At present, cancer is usually treated by chemotherapy, radiation therapy, and surgery rather than with drugs. But, as Jo mentions in her article, 900 cancer drugs are currently in phase I–II development. Cannabinoids for instance are usually associated with the palliative care of cancer. However, in The Webscout Karin Eichele (p. 61) explores the potential for using cannabinoids as inhibitors of tumour growth. Unfortunately, many promising new agents fail, not least because some tumours do not respond or pathways blocked by treatment are circumvented by the disease. Nevertheless, researchers are hopeful that in 10 years’ time it will be possible to stop even the most formidable advanced solid tumours from the colon, pancreas, and lungs. Jo quotes Weinberg, who believes that by then patients will have a normal lifestyle with a chronic disease. Personalized medicine has been hailed as a promising way forward. Interestingly, the term has been