To mark World Cancer Day on February 4, Livehealthy spoke to Dr Stephen Grobmyer, chair of the Oncology Institute at Cleveland Clinic Abu Dhabi, about the latest developments in cancer care in the UAE. Dr Grobmyer’s clinical care and research focuses on developing new approaches to prevent, diagnose and treat breast cancer.
Can you update us on clinical developments in the UAE?
There’s a lot happening with diagnosis and treatment. One of the most exciting things at Cleveland Clinic Abu Dhabi is the development of a free-standing cancer center. Most cancer patients need the help of multiple specialists — maybe a surgeon and a radiation doctor and a medical doctor, but also nutritionists and teams to help with physical rehabilitation and psychological wellness.
Cancer is common, but if caught early it is treatable and even curable. Treatments are getting very effective and there are new treatments we couldn’t have offered even just a few years ago. Many patients are living a long time with cancer so we are also focusing on survivorship: what we can do to improve quality of life, to reduce the chance of recurrence and how to look for secondary effects of treatment.
Cancer is best cared for by teams of experts and developing that team is critical. You can be in the hands of a great surgeon but if we don’t get the diagnosis absolutely correct and the imaging isn’t done perfectly, we could be embarking on the wrong path. Fortunately, we are having a lot of success in attracting some of the best people in the world to join us here to embellish what we already offer.
Which cancer treatment are you most excited about?
There are many but the one that’s most often discussed is immunotherapy. Years of research is now coming to fruition and into clinical reality.
Immunotherapy uses the patient’s own immune system to treat cancer and, in some cases we’re studying, even to prevent cancer. It’s leading to treatments for cancers where we traditionally had none to offer — for melanoma, an aggressive form of skin cancer, for example. Now we’re seeing amazing outcomes for patients with melanoma. Immunotherapy has also become a mainstay of treatment for lung cancer. We not only diagnose the patient, we can see at a molecular level what type of lung cancer it is, meaning the oncologist can clearly lay out a path that wasn’t possible before.
Immunotherapy can also have a role in other common cancers. The future is certainly bright.
How does immunotherapy work?
There are different types. One type is vaccination, which is using the body’s immune system to prevent disease. Cervical cancer is caused by a virus, so a vaccine will prevent it.
Then there are medications that can specifically go in and alter your immune response. They block signalling pathways within the body to allow the cancer to be attacked by the body’s own immune system.
Another method is to take some cells out of the body and manipulate them so that when they’re put back in, they attack the cancer. We are seeing outcomes that were never thought possible and I can see how in future we will be manipulating the immune system more.
Which cancers are particularly prevalent in the UAE?
Breast, colorectal and prostate are common, as they are in other parts of the world. Beyond that, the World Health Organization has identified thyroid and blood cancers as common, which is unusual.
There is also the age issue; patients are younger here than in other parts of the world. The recommended starting age for colon screening has been dropped because it’s occurring earlier, in 45- and even 40-year-olds. We certainly see a lot of younger women with breast cancer. Is that simply to do with population status or are we seeing different manifestations of the disease? We need to find out.
You have previously said the power to reduce the risk of breast cancer by as much as a third is in our own hands. Can that be applied to all cancers?
For sure, this is true for many cancers.
It’s well known that smoking is associated with lung cancer, for example. A lot of cancer is preventable through diet. For instance, eating a high-fiber diet reduces the risk of colorectal cancer.
In general, a healthy lifestyle leads to reduced inflammation in the body, and we know inflammation is linked to cancer. Stress is involved with cortisol levels, which are associated with chronic inflammation. We also know exercise is important for reducing stress and inflammation in the body.
Another way patients can be empowered is by knowing their family history of cancer. There are patterns that run in families and when that information is shared with doctors, it means you can be screened and checked earlier and we can do genetic testing to define that risk and then screen other family members.
Is it true that we all have cancer cells within us?
There have been large studies of people who died of, say, a heart attack and an autopsy found they had some form of pre-cancer. Undoubtedly there are pre-cancerous cells that don’t develop. Perhaps the immune system deals with them or perhaps they are latent and don’t progress. The important message here is that we have to assume they have the potential to manifest, so it’s a matter of finding out which of these what we call “occult cancers” will be problematic.
But we can already see that in future we will be able to check for cancer cells in the blood and diagnose or at least monitor cancer that way.
What questions do we need to keep in mind when we go for a consultation?
Number one is to go to a center where the doctors are focused on the cancer that you have. Cancer treatment is not like going to the ER — it’s a long-term relationship, so make sure you’re dealing with physicians that have a specific interest in your condition and with whom you’re comfortable.
Don’t forget the power of the second opinion. We encourage people to seek it, to make sure that others agree with what you’re being told, particularly for early stage cancer. If your team is in accordance with standard guidelines, that’s reassuring because you can’t undo surgery or radiation.
It used to be the habit for people in the Middle East to go abroad for cancer care, but times are changing. We believe in the benefits of sleeping in your own bed, being comfortable in your own surroundings, eating your own food, having access to friends and family — all those are very important. The UAE has been very good at bringing in a wide mix of physicians so people don’t have to travel.
What’s your opinion of alternative therapies?
It’s not that we don’t believe in them, it’s that we don’t think in most cases they are a reliable replacement for standard treatment. You know, those of us in the white coats — we come to work every day wanting to make people better. We tend to make our recommendations based on available data. Alternative therapies are new and maybe haven’t been studied as much. That doesn’t necessarily mean they’re invalid but we’re trying to rely on things that we know work.
We encourage patients to talk to their doctor to see how alternative therapies can be integrated into their treatment to reduce side effects or improve efficacy. What we don’t want is to diminish the effect of treatments that we know work.
How is the UAE doing on disease prevention and awareness?
Primary prevention is to do with lifestyle. The government is doing a great job in encouraging people to be active.
With secondary prevention — cancer screening related to age — there’s still a way to go. Colon cancer is one area where we really need more compliance because we can really improve outcomes. There ‘s a lot of fear about discomfort but there is no question that if we find something, with minimal intervention we can significantly reduce the risk of getting colorectal cancer. And there are new options coming up all the time, so it’s very important to talk to your doctor.
Speaking as someone who has had a screening colonoscopy, I can say it’s really not that bad. And isn’t it quite empowering to learn that everything is OK?
Dr Stephen Grobmyer was a guest on the Livehealthy podcast on February 3, 2021.
