Javier de Castro: "We cannot take resources from cancer research to give them to the coronavirus"

When a person is diagnosed with cancer, their life experiences a shake. It is not a simple scare, but an authentic earthquake that affects all levels: personal, family, work, social … It causes such an impact that at first the person is decomposed, confused, in 'shock', without knowing what to do or where throw, as if the brain did not know what order to throw to the limbs.

With these lines the Head of Medical Oncology at Hospital La Paz, Javier de Castro, its just posted 'Cancer. Survival Guide' (Encourages). It is not a self-help book, nor does it intend to distance the patient from the professionals who will accompany you in the consultation, but meet some needs that are often not met during the process.

The publication of the doctor, who accumulates more than 25 years as a specialist in oncology, aims to be a first dose of tranquility in the form of a manual with ordered, contrasted and updated information on cancer.

We chatted with the specialist, who is also coordinator of the Innovation Unit of the La Paz Research Institute, about how to cope with cancer, live with him and the impact of covid-19 in this dreaded disease.

QUESTION. Who is this book for and what is its purpose?

ANSWER. The book is aimed at patients diagnosed with cancer and their families. And its objective is to accompany and help face one of the most complicated processes of life through my experience of 25 years as an oncologist, but, above all, from the experience that patients have transmitted to me.

Q. How should the first ‘shock’ of a cancer diagnosis be faced?

A. When you are diagnosed with cancer, the first moment is like when a bomb explodes; people get up and don't know where they are or which way to go.

There are a series of stages that we all have to face in that first moment. The first to get out of this ‘shock’ is usually denial, in which some come to think that they are having a nightmare and that it may reach a stage of anger. Later the acceptance, negotiation and a start-up begins. They are the same phases that occur when we lose a loved one, when we grieve, lose a job or when we suffer a separation.

Javier de Castro. Photo: Luis Milabrán

We are talking about a disease that can transform our lives and even put it at risk. With which it is necessary to face it as what it is and not live it internally, because otherwise that person is not understanding the true scope of the disease. Nor the other way around, you can't be crying around the corners, because there are solutions and things that can be done.

The fundamental thing is to look for a medical team that you trust, that there is communication. This medical team not only helps by putting the treatments, it is also a guide on the way, on the journey that we have to make together. It is essential that people know that we have to make the journey together.

Q. How important is it to know the "enemy" we are going to fight against?

R. It is essential. Over the years we have advanced in the treatment and early diagnosis of these diseases and now we are living the time of the benefit of everything that has been investigated, becoming innovative, less aggressive and more effective therapies.

Q. How should you live with cancer?

R. After this first part of 'shock' that we have suffered, we must know how to manage it properly. You have to try to include it in your routine, even if your life is going to change, you have the ability to make it change as little as possible. There are people who can continue working, continue to maintain their normal life as a couple, their relationship with friends, travel … obviously adapting to each other's treatments.

Another tip is to follow small goal policies. If we have an illness that will make us go to the hospital a lot in the next six months, not planning for a year from now, but planning how to live these months. You have to try to live with it, but looking for goals that are achievable in the short-medium term so that much frustration is not generated.

We have to live together and try to combat the frustration caused by the disease. We must also look at other patients who have been able to cope well.

Q. Following advice, as stated in your book, is it important to take advantage of "until the last minute" when living with cancer?

R. It is essential. In the book I collect the experience of many patients who say that cancer has a positive part: that the nonsense ends. We get overwhelmed by those children who get bad grades or by that job that we don't get to; and suddenly this disease arrives that tells you what is really important in your life: enjoy the day to day.

Many patients say that cancer has a positive side: that the nonsense ends

We get up every morning and see a wonderful sun, but we do not pay attention because we think that it will be eternal and when this disease comes to us we begin to appreciate the little things more and take advantage of until the last moment.

This has also happened with the coronavirus. We thought we were immortal and, suddenly, an illness can kill, ruin or change all your life models.

Q. So, if for many patients the disease means that the nonsense ends … can it be considered as an opportunity?

A. Totally. Obviously from theory to practice there is a step. But it is true that from the experience of my patients, some have helped them to bond more with their partner, stop working like crazy or think much more about their free time.

In the end, like everything in life, you can live badly or well. But without overdoing it, cancer is a marathon that cannot be run in a 'sprint', you have to dose forces, seek alliances between friends, families and partners and there is the opportunity to live it in a positive way.

Concentration of health workers outside the La Paz hospital. Photo: EFE / JuanJo Martín

A. Chemotherapy remains an important treatment for patients. But it is true that we have learned to do enough chemotherapy so that there are fewer side effects. We have developed symptomatic treatments to reduce its effects. And also at the same time appear what are called targeted therapies, immunotherapies, hormonal treatments … which do not have so many side effects.

Q. What if everything goes wrong …?

R. It is something that unfortunately can happen and we have to be prepared to face this situation, both the patient and the health personnel and, of course, the family itself.

Logically, the end of a person's life is very sad, but you can also look for the positive parts of that end of life and, above all, face it with the maximum medical, family, psychological, palliative care support … This too It is helping a lot so that these painful situations can be improved, as far as possible and within this difficult circumstance.

It is the law of life, they say that we are born and die alone and that nobody is going to stay here. What we have to try in these diseases, when we cannot change the course, is that the last years can be the best possible.

P. As the times dictate, our conversation has flown the covid-19. How has the coronavirus affected the diagnosis and treatment of cancer?

R. I have had the great fortune, because of the hospital where I am, to be able to continue facing the treatment of cancer patients, despite the tragedy we are experiencing. It should be noted that, contrary to what was thought, many patients with cancer controlled with treatment do not have to have a further evolution with the coronavirus if they become infected.

Rapid diagnosis of these diseases is essential, losing months can be dangerous for the evolution of cancer

When it comes to diagnoses, we have to get patients with symptoms tested as soon as possible. We have seen how hospitals and health centers are collapsed; and how patients are afraid to go to health centers when they have a warning symptom. But it is very important to continue insisting that the rapid diagnosis of these diseases is essential, losing months can be dangerous for the evolution of a cancer patient.

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David brunat Ainhoa ​​Murga Graphic: Jesús Escudero

The patient who may have alarming symptoms of possible cancer has to try to go to his health system in any way, seeking to enter the system earlier. In fact, in our hospital, high-resolution circuits are being generated to put patients in contact to initiate diagnoses and treatments.

Q. Could this fear of going to health centers increase mortality from cancer?

A. It is still too early to tell. What we do know is that fewer patients have been operated on in March and April and that fewer diagnoses have been made from complementary tests; which could, unfortunately, possibly have a negative impact on a later diagnosis. But I would not dare to say that it has already had an impact on survival, although we have been warning since March that cancer treatment should be a priority.

We not only have to stop the pandemic, we have to keep the diagnoses and treatments of other diseases working

The help of the population is very important to try to spread this virus as little as possible. Thus the health systems are not stressed and do not reach the limit situation of March. Because we not only have to stop the pandemic, we also have to keep the diagnoses and treatments of other diseases working.

Q. Do you think cancer research has slowed down in favor of covid-19?

R. We have been with this nightmare for a very short time, only six months, but it is true that we are warning that this is a risk. The European Union, logically, has launched urgent research aid programs for covid, but we must not lose the north of the number of patients who die from diseases such as cancer after a year. We have to continue to maintain research efforts, which are clearly insufficient.

From scientific societies, such as the Spanish Society of Medical Oncology (of which he is a member of the Board of Directors), we have been warning that more means must be put in the fight against covid, but that research resources cannot be removed of a disease as important as cancer to give them to the coronavirus.

Q. Has anything been learned from COVID research that can be applied to cancer?

R. We have learned good things from the covid. We have seen how the systems have been more fluid, as telemedicine is being implemented, the citation systems are trying to streamline … But it has also hampered because clinical trials, which are often essential for cancer patients to receive very novelty, they stood still.

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We have seen that this cannot be stopped again, that it has to be ongoing. It is very important to favor circuits so that the system is up and running, so that the administrations of some treatments are more flexible, so that the bureaucracy that we have to do in hospitals for the indication of prescriptions or contracting clinical trials is streamlined. In the most intense months of March and April, many things were streamlined that were not streamlined in many years and now we want the good things that the covid has brought to stay.

Q. So if these efforts were dedicated, cancer research would advance much faster …

A. Exactly. Above all, the bureaucracy that we often have for the arrival of drugs, the arrival of clinical trials, that a patient can enter clinical trials of the health system, facilitate appointments … all these things are what the patient needs.