Health Matters: Open-heart surgery and the cure for cancer
Q. My young child needs open-heart surgery soon. I'm worried enough about the surgery itself, but what about the anesthesia? Should I be concerned about long-term effects?
A. The medical profession has been concerned about the possible toxicity of anesthetic agents — those used to put a young child to sleep so an operation or procedure can be performed — for a long time.
The good and bad news are the same — we don't have solid evidence as to their effect. It's good news because one would think that if problems with these agents were widespread, we'd know about it by now. The bad news is there isn't a sufficient body of good clinical trials evidence upon which to base a confident recommendation.
But, despite the lack of good information, the Food and Drug Administration, probably reflecting an abundance of caution, recently issued a warning regarding the use of sedative or anesthetic agents in children younger than 3 years of age who need prolonged or repeated use of such agents.
So, what to do? First, it is important to discuss this concern with your child's surgical team. If surgery can be delayed until your child is older than 3, it probably should be. But if it can't — and most open-heart surgery in toddlers can't and shouldn't be delayed — I would urge you to go ahead with the procedure if that's what your child's physicians recommend.
The concern about anesthetic agents is real but theoretical, while the benefit is evident in the many thousands of toddlers who have undergone successful open-heart surgery. Best wishes for a full and quick recovery.
Q. As I get older, I worry more about getting cancer. How is the War on Cancer going?
A. We have to go back to 1971 and President Richard Nixon, who started the War on Cancer, a major, focused research effort intent on finding a cure for cancer and thus improving the lives of millions of patients.
So, where do we stand nearly half a century later? I'd say that progress has been made, especially in our understanding of the biology of cancers. And progress in certain cancers, such as childhood leukemia (a cancer of the blood), certain lymphomas (cancers of the lymph glands) and testicular cancer, has been spectacular — most of today's victims not only survive but are cured.
Let me emphasize that — cured. But the impact of the effort has been more modest in the most common cancers that kill most people — cancers of the lung, colon, breast, pancreas and prostate.
One of the clear conclusions of the more than $100 billion cancer research effort is that cancer is not the result of a single factor; rather, there are a multitude of causes. So rather than expecting to see "the" cure for cancer in the foreseeable future, I think that we'll see some continuing progress in treating specific cancers. But progress likely won't be across-the-board or dramatic. Unfortunately, one thing that we've learned during this war is just how complicated the enemy is — make that enemies.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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