Dr. Howard Soule of the Prostate Cancer Foundation has long discussed the Three Ds of successful cancer treatment. Using Dr. Soule’s paradigm really allows us to understand the cancer treatment process and more importantly where we are failing in treating patients.
What are the three Ds?
Discovery is the inventing of a potential treatment. Discovery takes place in the lab where possible therapies are created and screened (see our podcast with Dr. Mary Anne Sader about drug discovery).
Development consists of taking the discovered investigational treatment and testing it by moving it from the lab to people. Development consists of evaluating the experimental treatment for its efficacy by using clinical trials.
Delivery, the final step of the Ds is how the drug is ultimately delivered to patients.
If any of these steps are missed, the drug will not benefit the people who need it although we do have weaknesses in all three of the steps our biggest problems surround the Delivery step.
Currently, delivery of our approved treatments has several issues. In the United States, we often find that the economic costs of cancer drugs create an enormous burden on patients and their families. All too often, the cost of drugs puts them out of reach of the people who need them.
The inability to afford cancer drugs is a problem for many people, but it is significantly more severe for our underserved populations, including African American, Spanish and Indian citizens.
We also see that the second D, Development has problems as the same underserved populations are often not included or choose not to participate in clinical trials. This means that we are approving treatments based not on the general population, but only on Caucasian people. We do know that drugs don’t necessarily work as well in different racial groups.
We need to find ways to resolve the problems we have with both of these Ds, Development, and Delivery. Until we can begin to change these Ds, too many people will continue to suffer and die before they should.