An Interview With Savio P. Clemente
Cancer isn’t just a disease for older people. Recent spikes in cancer incidence in people 20–40 years old is alarming. But there are a lot of modifiable factors in your control and it’s so important when people see changes in their body that they consult a provider about their concerns and ask which screenings might be available for early detection. Don’t let fear prevent you from having those conversations because early detection is your best chance at survival.
Cancer is a terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?
In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Dr. Joseph Alvarnas.
Joseph Alvarnas, MD, chief clinical advisor at AccessHope. He is also the senior medical director for Employer Strategy, vice president of Government Affairs, and a professor in the Department of Hematology/Hematopoietic Cell Transplantation at the world-renowned cancer research and treatment center, City of Hope. As a healthcare executive and practicing oncologist with more than 60 peer-reviewed articles published in various clinical journals, Dr. Alvarnas is a leading advocate on Capitol Hill for new technology and innovations in cancer treatments and value-based care.
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory? What or who inspired you to pursue your career? We’d love to hear the story.
As the only child of immigrant parents who sought a better life, I always knew I’d be a physician.
This is not easy work. What is your primary motivation and drive behind the work that you do?
It’s ultimately the patients who motivate me. For 25 years I’ve witnessed the courage, determination and unbreakable faith of those facing a cancer diagnosis–whether their own or a loved one’s. When I was the Chair of the American Society of Hematology’s Committee on Practice, clinicians would often ask how they could get better support in caring for their patients with complex cancers. That was one of the key reasons I became involved in AccessHope–to address this huge unmet need and bring greater access and equity in care.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
My hope is that I’ve made the biggest contributions in my countless conversations with patients and their families throughout my years of clinical practice. If I’ve humanized their cancer journey — whether they were at the beginning of it, near the end of life, or a decade following their cure — I’ve achieved all I can hope to do.
I’d like to think that I’ve also made contributions as a researcher, but a cancer journey is a human experience, not a technological one. That’s why I hope that I’ve most greatly contributed to the quiet conversations that no one else will ever know about.
Much of my work beyond patient care focuses on ensuring that scientific breakthroughs reach the patient and are accessible to everyone. I’m fairly active from a public policy perspective because I see a significant need for legislation to promote greater equity in access to the best cancer care. I’ve worked closely with the CancerX consortium, which is a public-private partnership aimed at finding ways to leverage technology to help patients have a more humanized care experience and a greater path to survival. I’ve also worked with the state of California to help individuals on Medi-Cal gain access to top cancer centers, as well as clinical trials to get the latest treatments. These days, I spend far less time working on scientific breakthroughs and more time focusing on how to bring these advancements to more people.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What is exactly cancer?
Cancer cells are abnormal. As a result of accumulated genetic abnormalities, they lose basic control of normal cellular functions. For example, normally a liver cell stays in the liver, it grows within the liver, it appears normal next to its peers within the liver and it doesn’t migrate to other parts of the body. With cancer, none of these things are true. There’s a loss of normal cell function, cells can appear to be bizarre and, over time, when a cancer metastasizes, cells from one tissue can migrate to other parts of the body. None of these are normal behaviors. Cancer cells can also divide without control. Normally, cells will grow in a certain number of divisions and cycles before dying. There is a process to program cell death called apoptosis, which tells the cell ‘enough already, time to stop.’ Cancer cells lose this property through the genetic and genomic mutations that make them immortal.
Another key property of cancers is that they can invade nearby or distant tissues. Either by direct extension, or by leaving the tissue of origin and traveling through the blood or lymph to any other place in the body — the brain, lung, bone — these are common sites of metastatic disease.
How can one detect the main forms of cancer?
Screening tests are used to detect cancer before symptoms appear. The earlier cancer is found, the better the chances for effective treatment before it spreads, which can lead to better outcomes.
Cancer screening may include a physical examination by a healthcare provider, along with other methods, such as X-rays, laboratory tests, or genetic tests. In many cases, a combination of methods — such as a clinical breast exam and mammography — can offer more comprehensive results.
You should discuss with your healthcare provider which cancer screenings you should have and when, based on your age, medical history, family health history, and other individual risk factors.
Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?
More and more Americans are surviving cancer. This is partly due to early detection of the disease, advancements in treatment, and lifestyle changes. The cancer mortality rate has decreased continuously since 1991, resulting in an overall drop of 33% and approximately 3.8 million cancer deaths averted.
A recent report found that the five-year relative survival rate for all cancers combined has increased from 49% for diagnoses in the mid-1970s to 69.2% for diagnoses during 2014–2020. The cancer types with the highest survival rates are thyroid at 98%, prostate at 97%, testis at 95% and melanoma at 94%, according to the report. Current survival rates are lowest for cancers of the pancreas, at 12%.
Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What new cancer treatment innovations are you most excited to see come to fruition in the near future?
In the 1970s, the school of thought was that we needed to find one single cure to eradicate cancer. Today, we know that’s not the end goal. Cancer is different from other chronic conditions and, because there are so many different types, it requires a highly personalized treatment approach.
Over the last decade, we’ve learned a tremendous amount about the basic biology of cancer, leading to the development of groundbreaking treatments. For example, much of the research focuses on identifying the specific biological targets, such as mutated genes or the biology of proteins on cancer cells. Researchers then manufacture molecules or new therapies designed to direct the immune system to go after the abnormalities. Unlike chemotherapy, which is indiscriminate and kills cells broadly, we’re moving toward a future in which new treatment innovations are highly specific in how they target cells.
Another area that looks promising is cellular-based therapeutics, such as using CAR-T cells, to treat lymphoma cancers. Once considered a fourth-line treatment, it’s increasingly used as a second-line treatment. In the U.S. alone, more than 200 clinical trials are investigating the use of CAR-T cells for solid tumors such as breast, lung and liver.
Research is moving at a rapid pace to develop these targeted therapies and the next challenge will be getting these new therapies to patients. Much of the research comes from large academic institutions with cancer subspecialists who are experts in specific cancers. There’s a huge gap in connecting patients to the expertise of subspecialists, and that’s a big part of what we do at AccessHope. Through remote expert case reviews, we get people the information they need to make the best treatment decisions. It’s similar to the idea of getting a second opinion, but much more automated so that the patient and their local oncologist don’t have to travel or do the heavy lifting of finding the subspecialist or manually navigating all the steps to get the case review.
What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?
- What people find and read online is not always accurate or relevant to their particular diagnosis. For example, there are well over 100 types of lymphoma — all of which behave clinically different. Only a clinical expert with extensive training and experience can discern fact from fiction and determine the best course of treatment.
- People diagnosed with cancer often think the treatment is worse than the disease itself because they are frightened of the toxicity of chemotherapy. I’ve seen how this can paralyze patients from asking questions about the treatment. Today, there are so many more treatment modalities that go beyond chemotherapy, surgery, and radiation therapy, which used to be the standard treatment path. We now use precision medicine, targeted therapeutics and explore genomics. Some cancers can even be treated with just one pill a day.
- Another myth is that there is a cure to cancer that, for some reason, the healthcare industry is keeping a secret. Or you’ve heard that someone you know has access to herbs or alternative treatments that you may not have access to. I always urge patients to beware of any treatments that have not gone through rigorous research and clinical trials.
Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.
- The fight against cancer was once seen as a mission to create increasingly powerful drugs — as much as the human body could handle — and pummel the disease into submission. Today, precision medicine has replaced aggressive drug therapies, improving cancer outcomes and patient quality of life. Oncologists no longer take a ‘one-size-fits-all’ approach to treating cancer and, for patients, it’s important to know that your treatment options are not limited to chemotherapy, radiation or surgery.
- I previously touched on how cancer is a human journey and just as humans are complex beings, so too is a cancer journey. Providing patients with resources for mental well-being, financial assistance, family support, and help navigating back into the workplace–all of these aspects are equally as important as the drug or therapy treatment itself.
- Cancer isn’t just a disease for older people. Recent spikes in cancer incidence in people 20–40 years old is alarming. But there are a lot of modifiable factors in your control and it’s so important when people see changes in their body that they consult a provider about their concerns and ask which screenings might be available for early detection. Don’t let fear prevent you from having those conversations because early detection is your best chance at survival.
- When a patient first gets a cancer diagnosis they often have tunnel vision. Completely overwhelmed with the idea of the journey ahead, they feel like they’re alone. Because of this, these individuals may not realize that they have a community of family and friends eager to support them, and access to clinical experts and organizations that can help navigate the process and deliver unbiased treatment information. It’s so vital for patients to seek and embrace help, especially in those early stages of a diagnosis when they’re making big decisions like the course of treatment.
- A cancer journey may start with the diagnosis but it certainly doesn’t end with the treatment or even remission. A patient’s survivorship is such an important, yet often overlooked, aspect of the overall journey. These patients go from a schedule of constant appointments with providers and specialists, and then once they’re fully treated they often end most of those relationships and only have ongoing care with a primary care physician. This abrupt shift can be very alarming and really necessitates ongoing support for the patient. That’s why cancer support solutions that address the patient’s entire, and long-term journey are so critical.
How can our readers further follow your work online?
My LinkedIn page is the best place to follow my work, https://www.linkedin.com/in/joseph-alvarnas-abab6175/.
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
About The Interviewer: Savio P. Clemente, TEDx speaker and Stage 3 cancer survivor, infuses transformative insights into every article. His journey battling cancer fuels a mission to empower survivors and industry leaders towards living a truly healthy, wealthy, and wise lifestyle. As a Board-Certified Wellness Coach (NBC-HWC, ACC), Savio guides readers to embrace self-discovery and rewrite narratives by loving their inner stranger, as outlined in his acclaimed TEDx talk: “7 Minutes to Wellness: How to Love Your Inner Stranger.” From his best-selling book to his impactful work as a media journalist covering resilience and wellness trends with notable celebrities and TV personalities, Savio’s words touch countless lives. His philosophy, “to know thyself is to heal thyself,” resonates in every piece.
Dr. Joseph Alvarnas Of AccessHope On The 5 Things Everyone Needs To Know About Cancer was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.