Cancer has been a prominent feature of the news cycle in the wake of President Obama's proposal for a Cancer Moonshot Initiative in his 2016 State of the Union Address. Obama's speech came about 45 years after President Nixon signed the National Cancer Act in December 1971, giving us the opportunity to reflect on what has been accomplished during these decades. One view is captured by Vincent T. DeVita Jr., MD, and Elizabeth DeVita-Raeburn in a memoir titled, "The Death of Cancer," an intensely personal account of 50 years of cancer research and practice.
It is hard to imagine someone who was more central in this effort in the U.S. than Vincent DeVita-a medical oncologist, former Director of the National Cancer Institute, a leader at Memorial Sloan Kettering Cancer Center and Yale Cancer Center, himself a cancer survivor, and the father of Ted, his son who died of aplastic anemia after eight years as an in-patient in the Clinical Center of the National Institutes of Health. His memoir complements the popular Pulitzer Prize-winning book and television series, "Emperor of All Maladies," by Siddhartha Mukherjee, MD, to give an insider's view of the early days of cancer chemotherapy trials at the National Cancer Institute that led to curative therapy for Hodgkin's lymphoma and all that followed.
Entry into Medical Oncology
The book begins with a candid account of DeVita's accidental entry into the then dark field of medical oncology in its infancy. It paints a graphic picture of the passion, commitment, scientific rigor, and foibles of the founding fathers of oncology at the National Cancer Institute at the time when DeVita began his training in Bethesda.
Like all such memoirs, it is laced with patient vignettes that illustrate the highs and lows of clinical research and patient care in oncology. In the 13 chapters, DeVita uses his own experience and path from investigator to leader in the government, then in academia, to trace the development of basic and clinical cancer research at the NCI and the rapid dissemination of these efforts to centers across the country, including the 69 NCI-designated cancer centers in the U.S. today.
Common Connection
Many of his observations from the clinics will resonate with every oncologist who has ever cared for a cancer patient and participated in a clinical trial. Oncology historians will enjoy his insider's view of working within a complex government machinery to propel scientific discovery and affect change; we learn that political acumen is just as important a skill in clinical care and research.
Clinical trialists will appreciate his description of the nascent clinical trials process, which has contributed so much to clinical care today, as well as his dissection of where we have gone wrong with some of the more bureaucratic aspects of clinical investigation today.
An Insider's Perspective
Where I might take issue a bit is with the highly critical chapter on the Food and Drug Administration, a vital organization that has strived in recent years to introduce new cancer therapies as quickly as possible while preserving scientific rigor and safeguarding patients.
In full disclosure, I myself read this book as an insider of sorts. As a medical student, I took a rotation on the pediatric oncology service of the National Cancer Institute where Ted was hospitalized and learned of DeVita as a leader and a father.
Some years later, I returned to train as a medical oncology fellow and encountered DeVita as Director of the National Cancer Institute, a larger-than-life figure who we clinical associates encountered with trepidation at grand rounds each week. Some aspects of medical training are immutable, and my own experience as a trainee had much in common with DeVita's description of his immersion in oncology some decades before; I expect many medical oncologists will also relive their own experiences in his prose.
In sum this is an entertaining, enlightening, and well-timed read for anyone who is interested in one highly influential man's perspective about the last 50 years of cancer science and therapy. It embodies the truism that good science leads to good medicine and showcases the considerable progress that has been made toward the death of cancer. It reflects the energy and courage that doctors and researchers have brought to the formidable challenges of the diseases we call cancer. And in the end, it is all about the patients-past, present, and future-whom we have the honor to serve.
HARDCOVER, AMAZON, ISBN-13: 978-0374135607, ISBN-10: 0374135606
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