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Hunting for a cure, providing the best care

Deborah Bruner 

Advances in science and technology are enabling cancer patients to live longer than ever before. Still, the everyday reality of cancer treatment is harsh.

The concomitant effects of chemotherapy and radiation can ravage healthy tissues while battling tumors. Oral therapies can come with a startling array of potential side effects and daunting price tags.

While many researchers race to identify new targets for treatment and formulate new therapies, a growing cadre of School of Nursing researchers is leading the nation in studies that examine the patient experience and how patient-reported outcomes can inform cancer care.

Deborah Bruner PhD RN FAAN, Robert W. Woodruff Professor of Nursing at Emory's Nell Hodgson Woodruff School of Nursing, is a well-known expert in cancer clinical trials and oncology nursing research through Emory's Winship Cancer Institute. She is associate director for mentorship, training, and education at Winship, newly designated by the National Cancer Institute (NCI) as a comprehensive cancer center for reducing cancer burden in Georgia. She is the first and only nurse to lead one of four adult NCI Community Oncology Research Programs. She also helped set new priorities for NCI clinical trials on symptom management and patient quality of life. In 2016, she was elected a member of the National Academy of Medicine.

"When you are in clinical practice, the physician mostly is interested in doing diagnostics and cure. In inpatient care, the nurse manages everything else—the symptoms related to disease and treatments, the environment around the patient to provide comfort and care, and the environment around the family to engender support," Bruner says. Nurses understand how evidence-based, supportive oncology care to families and patients decreases pain and suffering and improves quality of life. That knowledge has inspired Bruner to improve the patient experience in a rigorous, scientific way.

Over the years, her work has informed the NCI's adverse event reporting system, an important tool used to grade symptom toxicities associated with chemotherapy drugs, immunotherapies, precision medicine, radiation medicine, and surgery in cancer treatment—work that has made patient-reported outcomes as important in changing clinical practice as clinical outcomes.

Late last year, Congress passed the 21st Century Cures Act, authorizing $1.8 billion over seven years for NCI's Cancer Moonshot, a program designed to accelerate cancer research by making more therapies available to more patients, while also improving early detection and prevention of cancer.

Earlier this year, Bruner presented "Challenges in Cancer: Moonshots, Miracles, and Myths" during an academic symposium celebrating the inauguration of Emory's new president, Claire E. Sterk. In her talk, Bruner challenged the current funding model that prioritizes cures and precision treatments that benefit a fraction of cancer patients over research that benefits larger patient populations.

Because new precision medicines, immunotherapy treatments, and other "miracle" drugs are so costly, these drugs often are out of reach for the small number of patients who qualify for them. The discovery of the EGFR mutation in lung cancer offers a compelling example.

"Now we have immunotherapy drugs to treat patients with that mutation, and 10 percent of those patients had long-term survival and some have even been cured," Bruner says. "That is miraculous. But only 10 percent of lung cancer patients have the EGFR mutation, and only 10 percent of those patients experience the miracle."

Precision medicines come at another price: the possibility of side effects or even death.

"Some drugs, unfortunately, kill patients, and many of the side effects are terrible," Bruner notes. "Taste changes mean meals with family and drinks with friends will never bring the same pleasure again. Ulcers in the mouth mean you can't eat or drink at all. Blisters on your hands and feet mean you can't walk or touch or hold your child or play the piano. These side effects have not gotten enough attention. We are paying a lot of attention to cures but not to living with these cures."

Emory is an international leader in developing ground-breaking cancer treatments. It is also a leader in symptom science and quality of life.

"Precision medicine is not just genetics or immunotherapy," Bruner says. "Real precision medicine also takes into account environmental and lifestyle factors and puts them all together. How do we make sure a patient gets a $10,000 drug at home and takes it at noon and bedtime with the other drugs they are allowed to take? That is symptom science, and we have great nurse scientists at Emory who are studying that."

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