Cancer Treatment In The United States: From The Eyes of a Young Doctor

Rochana Acharya^a

^a B. P. Koirala Institute of Health Sciences, Dharan, Nepal

Background

As a doctor trained in the serene yet demanding landscape of the Himalayas in Nepal, I harbored a deep belief that a late-stage cancer diagnosis often signaled a hopeless outcome. In my country, cancer is commonly viewed as a death sentence, instilling fear and despair in both patients and their families. I recently had the opportunity to shadow cancer specialists at the beautiful Grace Clinic in Wisconsin, where the quality of care fostered a sense of optimism. After a short time at this cancer center in the United States(US), I had a significant shift in perspective on cancer care.

My first encounter with cancer in the US was a man in his 40s in a wheelchair. While his 2-year-old daughter had just started running, he felt wobbly and unsteady when he could not walk anymore. His blood work revealed Multiple Myeloma, a cancer of antibody-producing cells. As his cancer was in the brain, he was seen promptly by myeloma specialists. His multiple myeloma specialist sees 30 or more patients of this rare cancer every day, performs cutting-edge trials for challenging cases, and visits worldwide for updates on this type of cancer. This timely referral for the patient meant he would get world-class treatment from one of the leaders in his disease, which has been deemed incurable to date.

If this gentleman were in a low-income country like Nepal, where the Gross Domestic Product (GDP) is around $40 billion, the journey to a diagnosis could feel like an uphill battle due to limited resources. In contrast, with a GDP of approximately $27 trillion, the United States boasts one of the world's largest and most diverse economies, with robust technology, finance, and healthcare services sectors. [1] Imagine the life of a 40-year-old family man filled with fear and uncertainty as weeks stretch into months without a diagnosis. Delays in diagnosis arise from financial barriers or even natural disasters that sever access to the nearest clinic. With few specialists available, precious time slips away, and the disease quietly progresses. This gentleman would confront the harsh reality of paralysis without ever knowing what caused the illness.

The healthcare system in the U.S. was entirely new to me. I observed that cancer patients here maintain a positive outlook on their health and actively seek treatment. Many arrived at the clinic equipped with a folder and a pen, the initial pages filled with questions about their daily health, ongoing treatments, and future concerns. Family members stood by, providing steadfast support. They kept diaries to track the doctor’s plans, medications, and side effects, ensuring they asked questions for clarity. This participatory approach to cancer care creates a robust support system that helps alleviate patients’ fears. While doctors work diligently to provide the best care for each individual, patients' responsible and proactive attitudes motivate clinicians to go above and beyond. This collaborative effort fosters hope and empowers patients, challenging the traditional view of them as fragile and marginalized in decision-making. [2]

Another notable shift in cancer care in the United States was the focus on research and patient awareness. After medical school, I participated in a clinical trial in Nepal where patients were very anxious about the trials. However, the atmosphere in the U.S. was different; patients actively sought out doctors engaged in experimental treatments, eager to explore alternatives to conventional methods. Many came well-informed about their conditions and shared the doctors’ enthusiasm for the potential of new trials. I met a man with prostate cancer who had undergone surgery, chemotherapy, hormonal treatments, and radiation without success. I braced myself for a somber encounter but found a well-groomed, smiling individual who joked about how his weight loss might give him a shot at a modeling career. He understood that participating in this trial might not save him, but he took pride in contributing to knowledge that could benefit future patients. His resilience and positivity transformed my perception of advanced cancer; what might represent "the end" in my home country felt like a new beginning of possibilities here.

The treatment landscape of cancer has significantly evolved, shifting towards immuno-oncology. For many years, we relied on toxic chemotherapy, which indiscriminately killed both cancerous and healthy cells. This approach weakened patients' immune systems and left them susceptible to infections, hair loss, and the inability to enjoy food. The personal toll was immense; patients faced isolation due to infection risks, dealt with the visible signs of illness, and lost simple pleasures. By the time they reached the clinic, they were often battling not just cancer but the debilitating effects of the treatment itself.

Our patient had undergone Chimeric Antigen Receptor (CAR) T-cell therapy. In just nine days, he went from being a wheelchair user to walking confidently, filled with newfound hope. His remarkable recovery was thanks to one of the latest advancements in myeloma treatment, made possible through innovative research and the bravery of patients who embraced these new approaches. Cancer care is no longer just about attacking the disease; it’s about understanding why cancer cells grow and leveraging the body’s natural ability to fight back. CAR-T therapy, which I once only read about in textbooks, works by taking a patient’s T cells, modifying them to recognize cancer better, multiplying them, and reintroducing them into the body. These enhanced T cells then precisely target and destroy cancer cells. [3] It’s a leap forward in precision medicine, providing hope for a more targeted and enduring fight against cancer.

My experience with cancer care in the U.S. has been truly transformative. The best part was that patients and families primarily drove their health care. Patients have their voices, share their stories and struggles, and actively participate in informed decision-making. I believe in empowering people to take control of their journey, whether navigating Highway I-40 or undergoing cancer treatment; they should be in the driver’s seat.

Conflict of Interest

Rochana Acharya serves as a non-paid research assistant at EhealthyInfo. She completed a non-paid observership at the Grace Clinic at Clinical Cancer Center, Medical College of Wisconsin, from 09/01/2024 to 09/30/2024. There are no other conflicts of interest to declare.

References

1. GDP (Current US$). World Bank national accounts data, and OECD National Accounts data files. Available at https://data.worldbank.org/indicator/NY.GDP.MKTP.CD. Assessed: 2024 Oct 27.
2. Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads D. What factors affect patients' ability to access healthcare? An overview of systematic reviews. Trop Med Int Health. 2021;26(10):1177-1188. Published 2021 July 4. doi: 10.1111/tmi.13651.
3. Gulla A, Anderson KC. Multiple myeloma: the (r)evolution of current therapy and a glance into the future. Haematologica. 2020;105(10):2358-2367. Published 2020 Oct 1. doi:10.3324/haematol.2020.247015.