History of Cancer Treatments

The need of cancer victims is to be cured, or at least to have their lives prolonged.

From the years 200 to 1800 CE, following the teachings of Aristotle and Galen, cancer was believed to be a consequence of the coagulation of ‘black bile’ (melancholia) in the target organ. Black bile was one of the four metaphysical humours (black bile, yellow bile, phlegm and blood) that needed to be in balance for perfect health. The therapeutic responses to this belief were purgation (enemas), leaching, cupping, bloodletting and extreme diets. There was never any evidence that the treatments worked, but undoubtedly the patient’s suffering was increased. Such ‘ancient wisdom’ is best confined to the rubbish bin of history. In the past 200 years, we have learnt much about the exquisite mechanisms of the body at molecular, cellular, whole-organ and whole-person levels. These realities are more beautiful, awesome and mysterious than ever dreamt of in Galen’s philosophy.

In the late nineteenth century, with the development of anaesthesia and antisepsis, surgery began to replace irrational nostrums. Not long after this, radiotherapy was introduced, which increased the chances of local control of cancer. These early successes in functional and symptomatic relief led to a period of complacency in the medical profession, which only began to be shaken with the development of effective (albeit toxic) medical regimens for treating cancer about 30 years ago.

At the same time, the randomised controlled trial (RCT) was introduced to evaluate, critically, combinations of these three modalities, measuring both efficacy (improvement in survival) and tolerability (side effects and quality of life). Using this approach, we have made slow incremental improvements and can now negotiate with our patients ‘trade offs’ between increasing length of life and the toxicity/side effects of the treatments with a degree of precision and individualisation that increases with each trial completed.

We have still a long way to go and once again there is no room for complacency. The challenge for the oncologists of today is to get the correct balance between the curiosity (scientific interest in helping patients of the future) and the compassion (helping patients of the present) in order to reach the optimal-efficiency level of care both in routine clinical practice and for the patient treated in the context of clinical research. Against this background, let us consider the meaning of needs for complementary and alternative medicine (CAM).