Commission on Cancer Lecture makes case that strong medicine relies on math

Sir Murray S. Brennan, GNZM, MD, FACS
Sir Murray S. Brennan, GNZM, MD, FACS

Medicine cannot avoid math, nor should it, according to Sir Murray F. Brennan, GNZM, MD, FACS.

Drawing from a lifelong interest in mathematics databases and prognostic outcome tools, Dr. Murray, Senior Vice-President of International Programs and Benno C. Schmidt Chair in Clinical Oncology, Memorial Sloan Kettering Cancer Center, New York, will assert there is a better way than the status quo in the Commission on Cancer Oncology Lecture, Cancer Care: Medicine Meet Math. The lecture will begin at 1:00 pm Wednesday, October 7, and be available for on-demand viewing through virtual ACS Clinical Congress 2020 meeting platform through December 31.

When Dr. Brennan was in medical school, he took an unusual path for the time and completed a degree in mathematics. He was able to continue to foster his interest in math after his arrival at Memorial Sloan Kettering Cancer Center in the 1980s, creating a series of databases starting with rare tumors and proceeding to more common tumors.

An important part of any evaluation or database is the creation of both a numerator and denominator, he explained, but many surgeons are numerator doctors. “We all remember the good news,” Dr. Brennan said. “We are all saddened by bad news, but we have little idea of the prevalence of either. There is no denominator.”

After years as a busy clinical surgeon, when Dr. Brennan made the decision to stop operating, he also decided to turn his focus to educating physicians about the importance of math and medicine. He argues that doctors need to apply more math to clinical research outcome analysis.

Traditional prognostic tools also require reevaluation. In this capacity, staging systems are limited, he said, because even among people who have advanced disease like metastatic colon cancer, there are wide variations.

“The common event is they all, as a group, do badly, but built into that is some do terribly—100 percent death in weeks,” Dr. Brennan said. “And others, a small percentage, are alive at five years. So, the staging systems are good for the group, but they are no good for the individual.”

Nomograms—or predictions based on the information you have about what might happen to an individual—can help guide treatment, he said.

The cost of health care in the U.S., where there is about an even split between private and government-supported health care, also is at the intersection of math and medicine. The top-tier cancer care available in the U.S. has restricted availability due to expense.

“People are going bankrupt and not being able to afford their health care, but that too is a mathematical problem,” he said. In other parts of the world, health care is more likely to be heavily supported by the government. Dr. Brennan doesn’t make a case for universal state-supported health care coverage, but says it is critical to acknowledge where health care is coming from and the mathematical consequences that follow.

“If you go bankrupt, you are twice as likely to die of your cancer as a patient with a similar disease who does not go bankrupt,” Dr. Brennan said.

While critiquing the medical establishment, himself included, he sees one solution in the approach to clinical trials. Rather than conducting a trial and waiting to see results after months or years, Dr. Brennan advocates for using math for a more tailored selection of participants.

“You cannot enter a trial unless there is a mathematical probability that you need to,” he said. “Are you the person who does or does not need what I am offering, whether it is surgery, radiation, chemotherapy, or are you the person who absolutely must join us because you are the one most likely to respond?”

Mathematical tools like the previously mentioned predictive nomograms already exist to confront this question.

“You do not want to enter into a clinical trial with a disease if you know that the particular mutation that that disease carries does not respond to drug XYZ,” he said. “We can all provide better, more cost-effective cancer care if we include the math in the medicine.”

The Commission on Cancer Oncology Lecture, established in 1988, examines major developments in oncology and focuses on the surgeon’s role in caring for cancer patients.