Team:Fudan/HP/Silver
As students from schools of biology and medicine, we want to make the world a better place by helping people fighting illness. Cancer is a worldwide problem that nobody can ignore when talking about medical issues. According to CNBS, more than 2 million people died in 2015 because of malignant tumors in China. With the goal to improve cancer treatment, we found it of vital importance to first conduct an investigation about cancer and its related therapy.
To understand the current circumstance of cancer treatment, we first searched for documents data bases about cancer treatment to establish a general concept. Traditionally, cancer therapies are divided into three major categories: surgery, chemotherapy and radiotherapy. These therapies have been tested by time with certain degrees of positive effect on patients, but far from satisfying. Taking hepatocellular carcinoma (HCC) as an example, patients who have advanced HCC without treatment can only live up to 3 months. Even with surgery or related treatment, the five-year survival rate was only 15 to 40 percent. Though the gap between ideal and reality is still wide, some emerging therapies provide us with new hope. During the process or our research, we came across the rising therapeutic method, cancer immunotherapy.
Cancer immunotherapy, which means treating cancer with our own immune system, is a promising way to cure cancer [1]. Apart from the traditional treatments, it focuses on not only tumor cells but also immune cells in our body. Based on the knowledge that certain types of proteins or macromolecules presented on the surface of tumor cells’ plasma membrane, scientists hope to “identify” and then “kill” tumor cells preciously [2]. After decades of research, a number of immunotherapies have been created to deal with multiple types of malignant tumors, from CIK to CAR-T in cell therapy (a branch of immunotherapy) [3] and all kinds of cancer vaccines [4]. Plenty of surveys and reviews have also been done since the new methods emerged [5-7]. The results are encouraging, for the conditions of patients with several types of cancer, like leukemia and melanoma, has been improved significantly [12]. Cancer immunotherapy is thus regarded as one of the most possible solution to cure tumor completely in the near future, and a number of scientists set out to develop it, both foundamentally and clinically. Shanghai, as the frontier city of medical service in China, plays an important role in cancer identification, characterization and treatment. Considering the importance of immunotherapy, its development in Shanghai should have a crucial influence of cancer study all over China. Although traditional treatments including surgery, chemotherapy and radiotherapy have been wildly used in many hospitals here [8], few survey has been done about immunotherapy [9]. Despite the agreement has been reached that specific immunotherapy is more likely to be the bright future, researches seems to concentrate more on pure technology advancement but not application [10, 11]. We still lack an overall awareness of immunotherapy in Shanghai.
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In order to fill the blank of immunotherapy research, we mainly focus on the application situation of cancer immunotherapy, while also including the knowledge level of doctors, attitudes from the professional as well as the public. Through giving out questionnaires, holding interviews and in-field interactions in hospitals, we want to depict an outline of immunotherapy development in Shanghai, thus to provide a reference for officials and government for further decisions. ◆See details about the Questionnaire... |
Though questionnaire can help us obtain a wide range of opinions, the result is sometimes vague. To make up for the gap, an interview of the authority in this field is essential. We luckily got connected to academician Wang Hongyang, member of China Engineering Academy, in the Eastern Hepatic Surgery Hospital, who made great progress in the field of liver cancer treatment and discovered the HCC tumor antigen GPC3. ◆See details about the Interview... |
Clinical trials both at home and abroad indicate that this is likely to be a "promising" treatment. However, during the data collection we still found some of the neoplastic physicians who are confused about the concepts. This is quite a serious situation. For doctors in the other departments, immunotherapy may not be a subject of expertise, but a positive attitude is always encouraged.
In this survey, doctors generally have a negative attitude toward immunotherapy. The characteristics of a doctor's career may make them more concerned with the side effects and risks, while retaining the benefits of immunotherapy. From some aspects, this means that doctors may still have a limited understanding of immunotherapy, and that knowledge updates are relatively slow. Also, it shows that immunotherapy requires more research and clinical trials, real technological advances are key to the development of therapies. From another angle, this outcome also reflects some positive information that oncologist doctors have been very cautious in dealing with various newly emerged treatments. This is the responsibility for the patient's life, respect for nature. If we blindly believe in the much-vaunted therapies, the rigor of medicine is hard to show.
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The frequency of doctors' knowledge refreshing is satisfactory, but it can still be strengthened. At the same time, we have noticed that doctors lacked the use of new media on the Internet. They seemed to use more traditional methods. The convenience of new media delivers hot news at spot and rather quick. In our opinions; it is worth taking advantage of for doctors. About the public, the awareness of immunotherapy is more inadequate. In the sampled population, the subjects were mainly college students. As the frontier of the society, young college students are usually those who know most of the cutting-edge techniques. While nearly a third of the respondents have no idea for the immune therapy, it is somewhat inadequate. As for those who had learned about related information, most of them get their knowledge from news or events, rather than solid materials like journals or academic conferences.
Those who at least knew something about immunotherapy answered the remaining questions, while the result was quite interesting. Even without an accurate understanding of immunotherapy, most people remain neutral or even optimistic. Few people express a direct rejection of immunotherapy. When it comes to a situation that immunotherapy may be required, the choice of most people is to listen to the doctor's advice and search for relevant information.
As for frequency, even those who know about immunotherapy have relatively low frequency of getting in touch with related information. There is a relatively wide range of approaches, and there are more examples from the media. This may relate to a relatively young sampled population. At last, from our view, immunotherapy should be regarded seriously. Tighter regulation suggests that the government attachs more attention to this field, and the creation of various projects and funds represent national active attitudes to try. As we still know very little about the mechanisms of cancer, the importance of basic medical research must be strengthened. Meanwhile, clinical trials should be carried out in the context of basic research support, thus promoting the overall development of the subject. The discussion of the impact of public sample on the results of the study The sample of the popular questionnaire is far from the actual composition of the entire Shanghai population. Our public questionnaire is spread through the WeChat platform, this inevitably led to the uneven distribution of samples in general. The final sampled population actually includes a large proportion of Fudan University students with a high level of knowledge that is far more than the overall level, and the age is relatively concentrated in the youth range. So for the condition of whole Shanghai, the sample here is a relatively small group of people who know a lot about immunotherapy. In this case, the general understanding may be far below the result in this survey. The discussion about the experts’ self-assessment of their knowledge level As for the doctors in this survey are mainly cancer related, the expectation of knowledge level is quite high at first. However the actual results were not as good as expected, and a significant number of experts still had a fairly modest assessment of their knowledge level. On one hand, this may result in the modesty of doctors, not to be overfull in their words. Another possibility is an actual lack of deep understanding. We did interviews with some doctors and found that sometimes there was a lack of knowledge about cutting-edge research. This requires a continuous refresh of the knowledge. Attention must be paid by relevant hospitals and institutions, through an appropriate mechanism to promote the doctors’ understanding of emerging technologies.
Cancer immunotherapy is still a naive therapy in some degree, so the innovation and development of related technology is of the first importance. Based on this believe, we came up with this project of SwordS. Explore our project to witness the journey of conquering cancer by [SwordS]! For cancer patients, what they need is not only treatment in medicine, but also treatment in humanity. We think a warm sociality would be beneficial, so we conduct the social activity, the [Flower Whisper]. The insufficiency of bio-engineering knowledge in public is an important reason why people have antipathy to new drugs or therapies, though they are helpful. We considered that a friendly and interesting way to popularize related knowledge would be helpful. Thus we develop the board game, [Cell War].
[1]. Chen, W., Zheng, R., Baade, P. D., Zhang, S., Zeng, H., Bray, F., Jemal, A., Yu, X. Q. and He, J. (2016), Cancer statistics in China, 2015. CA: A Cancer Journal for Clinicians, 66: 115–132. Doi:10.3322/caac.21338.
[2]. National cancer Institute, types of cancer treatment. Accessed date: April 6, 2017.
[3]. Bruix J, Gores GJ, Mazzaferro V. Hepatocellular carcinoma: clinical frontiers and perspectives. Gut. 2014 May;63(5):844-55. Doi: 10.1136/gutjnl-2013-306627.Epub 2014 Feb 14. Review. PubMed PMID: 24531850; PubMed Central PMCID: PMC4337888.
[4]. Harding JJ, Abou-Alfa GK. Treating advanced hepatocellular carcinoma: How to get out of first gear. Cancer. 2014 Oct 15;120(20):3122-30. Doi: 10.1002/cncr.28850. Epub 2014 Jun 4. Review. PubMed PMID: 24898783
[5]. Song MJ, Bae SH. Newer treatments for advanced hepatocellular carcinoma. Korean J Intern Med. 2014 Mar;29(2):149-55. Doi: 10.3904/kjim.2014.29.2.149. Epub 2014 Feb 27. Review. PubMed PMID: 24648795; PubMed Central PMCID: PMC3956982.
[6]. Li S, Yang F, Ren X. Immunotherapy for hepatocellular carcinoma. Drug Discov Ther. 2015 Oct;9(5):363-71. Doi: 10.5582/ddt.2015.01054. Review. PubMed PMID: 26632545.
[7]. Lesterhuis W J, Haanen J B, Punt C J, et al. Cancer immunotherapy – revisited. [J]. Nature Reviews Drug Discovery, 2011, 10(8): 591-600.
[8]. Higano C S, Schellhammer P F, Small E J, et al. Integrated data from 2 randomized, double-blind, placebo-controlled, phase 3 trials of active cellular immunotherapy with sipuleucel-T in advanced prostate cancer†[J]. Cancer, 2009, 115(16): 3670-3679.
[9]. Fesnak, A.D., C.H. June and B.L. Levine, Engineered T cells: the promise and challenges of cancer immunotherapy. Nature Reviews Cancer, 2016. 16(9): p. 566-581.
[10]. Ito F, Chang A E. Cancer immunotherapy: current status and future directions. [J]. Surgical Oncology Clinics of North America, 2013, 22(4): 765-783.
[11]. Cox L, Esch R E, Corbett M, et al. Allergen immunotherapy practice in the United States: guidelines, measures, and outcomes. [J]. Annals of Allergy Asthma & Immunology, 2011, 107(4): 289-299.
[12]. Elenburg S N, Blaiss M S. Current status of sublingual immunotherapy in the United States. [J]. World Allergy Organization Journal, 2014, 7(1): 24-24.
[13]. Silverberg N B. The status of immunotherapy in the United States, 2002. [J]. Cutis, 2002, 70(3).
