Ken always makes great documentaries. Kathy's comments are spot on. I wonder if they will ever go back to ancient ideas and look at prevention and some things that may have worked before and been discounted, or even natural compounds not really tested yet. the beginning of wisdom is to say I don't know and maybe start at a new place with a new approach, I know some of that IS happening right now. Also, there seems to be some courses that are money makers and the patient dies anyway. I know a personal friend could have had possible 7 years of additional life as Cancer Treatment Centers of America had a clinical trial but they could not help the patient if he had been to radiation already, sad. I know Ken and his team can really explain complexity to the lay audience (hey they sorted out the Civil War) so it is great to see a national debate on this. Also PBS next year will give the history of nursing and poet/male nurse/patent clerk Walt Whitman his own mini-series in historic Alexandria. it will be a must watch for those who love the history of medicine!

The language used around cancer and in provider-patient communication impacts the choices patients make. If every patient is "fighting" cancer or waging a "war," we shouldn't be surprised that patients opt for more radical treatments or those with greater toxicities. You can't win a "war" with half measures, and war comes with casualties, so if we use the "fighting a war" metaphor, perhaps patients interpret this as suggestion to pick the more substantial "weapons." I hope that Emperor opens up a discussion about these terms and others, such as the idea that the patient "failed" the therapy. No, the therapy "failed" the patient.

Hopefully the program will stress the human behaviors that contribute to causing so many avoidable cancers.

The first episode did a good job of highlighting the outsize role of pediatric oncology clinical research in launching the cancer research enterprise for adult patients. The suffering of a child has a unique impact on parents and family, and a willingness to engage in unproven therapies in the hope of a cure. I'm glad the film reminded us of the contributions of these children and their families to advancing cancer research and the development of new therapies. It's not lost on me that while our market-driven drug development system has yielded many new therapies for adult cancers, pediatric oncology is too small a "market" to attract much attention from drug developers. Given that so many children gave their lives in the pursuit of scientific advances that affect ALL cancer patients, do we owe them a renewed investment in finding new therapies for childhood cancers?

Last night I was clicking through the previews for Cancer: The Emperor of All Maladies on the PBS Apple TV channel, and came across the clip of Ken Burns talking about his mother's cancer. He tells of how he never knew a time when she wasn't seriously ill, and how she'd died when he was eleven years old. Those experiences were, in large part, what drove him to produce this series.

To a degree, I can relate. My dad's first cancer was diagnosed when he was in his forties, and I was four. That one was cured with surgery and radioactive iodine. He developed another when I was in high school, cured with surgery, then a third when I was in college. That one was incurable and despite resections and radiation and chemotherapy, it's the one that took him from us. This was over fifteen years ago, and still it's rare that a day goes by when I don't have a thought about it.

I'm surrounded by reminders, because now I'm training to be a hematologist/oncologist. The disease responsible for my first experiences with tragedy has been all around me for the last three years. I've spent hundreds of hours learning the details of treatment guidelines, trial data, and chemotherapy regimens, and the whole time the memories of watching it all from the other side of the desk have floated just below the surface.

The first two hours of the series are masterful storytelling. Watching the history of cancer research unfold, braided with the stories of the two young patients with leukemia, tugged me across the range of emotions. The narrator articulates this tension better than I can when describing the early days of leukemia therapy: "[Sidney] Farber's certainty that a cure would be found helped keep despair at bay. The Jimmy Fund Clinic, one visitor wrote, seemed suspended between two poles, both wonderful and tragic. Unspeakably depressing and indescribably hopeful."

You can imagine that my experience of learning to treat cancer has traversed a similar emotional landscape. Through medical school and residency, and now through fellowship, there were times when I was afraid the sadness would be too painful a reminder. There were also days I couldn't fathom doing anything or being anywhere else, because the rewards of working with cancer patients and their families are immeasurable. As treatments improve and new agents are discovered, we are changing the character of cancer itself.

Ken Burns describes why he moved forward with this video project. The void that his mother's illness left in his life is a driving force for him. His words: "As much as you want to move away from it, you have to move toward it." That sums it up perfectly.

I agree with Dr. Mukherjee that identifying a cure for cancer is one of the greatest challenges we face in human history. We as the cancer-treating community are where we are today because our predecessors and a group of brave patients chose to move toward this challenge over the last century. Rather than try to avoid the unspeakable depression that cancer threatens to impose, they chose to envision the indescribable hope for a cure.

This is the hope that we all hold, and someday we will find this hope realized.

Kenneth Bishop MD,PhD
Hematology/Oncology Fellow
Brown University, Providence, RI

John Marshall was right - the waves of emotion are tough tonight. As a breast cancer specialist its hard to watch tonight's episode without a revolving slide show of current and former patients running through my head.

The opening of today's episode encapsulated all the reasons I became an oncologist - fascinating biology that seemed to hold the keys to life and immortality, amazing patients who are willing to share their lives with us in such a deep way.

Nice to see the role of patient advocates and individual patients who were brave enough to go first recognized

Just finishing a tough day in clinic....ended with learning that one of my patients with metastatic disease just had her medicaid cancelled. The reason - her husband who is also being treated for metastatic disease was granted disability so their income was too high. They missed deadine for signing up for HIP because he was in ICU. Will the last installment dare discuss the problem of spiralling costs and the number of our patiens who are bankrupt?