Experienced Oncologist Shares Pragmatic Approach

Dr. Luis Augusto Casanova.

As a young boy in Callao, Peru, Luis Augusto Casanova broke his femur in a serious car accident. He lay in bed for one year, endured three surgical procedures, and had to learn to walk again. From that experience, he says, "I always thought I would have to be a doctor." He imagined how he might treat his patients differently, and how medical advances might transform the practice of medicine in his country. He trained in Medical Oncology at Universidad Peruana Cayetano Heredia and at Peru's premier cancer center, Instituto Nacional de Enfermedades Neoplásicas (INEN) and earned a three-year fellowship in cancer immunology at Memorial Sloan Kettering Cancer Center in the United States.

Today, Dr. Casanova is a clinical oncologist specializing in lymphomas and a professor at INEN "Eduardo Cáceres Graziani" in Lima, where he has been working since 1976. He encourages his students to deal realistically with the diagnosis of cancer, while doing what is best for the patient.

"Many doctors try to protect patients by withholding information about their condition, but I believe the patients deserve to know what is happening to them." Cancer is the second or third most prevalent cause of death in Peru, a country with limited resources for cancer treatment. His hospital provides patients with a high quality of care. However, there is more to cancer control than treatment. "The challenges we face are in relation to education and prevention," he says. "Public Education is not adequate. Prevention and screening are too expensive to be widely available. And living conditions for many people are poor."

A high fraction of cancers in Peru are associated with chronic infectious diseases and Dr. Casanova is concerned about the role of polluted drinking water and spoiled food. "Everyone has a television, but not a refrigerator," he says wryly. "Some don't have running water. We are trying to use small radio and television spots to reach the citizens of Peru about food safety and hygiene."

Without a national cancer registry in Peru, Dr. Casanova says the trends in cancer incidence are imprecise, but the pattern of cancer appears to be moving towards that seen in more developed countries. "In Lima, cervical cancer has decreased, but breast cancer and prostate cancer have increased. We don't have good epidemiological studies, except in Lima and Trujillo."

Still, the prognoses are improving. Since Dr. Casanova first began to practice cancer medicine more than 30 years, he says, more patients are living longer with cancer. "It used to be that those patients who were not surgically treated for lung cancer would die within six to ten months. Now they are living for two or three years. The same with advanced breast and ovarian cancer. We can offer a good quality of life for many patients. We can now treat tumors that were once considered terminal, and palliative care has improved significantly."

Dr. Casanova emphasizes to his students the importance of treating patients with terminal conditions, and to share their knowledge as they embark on their own medical careers. "I tell them they have to know how to give palliative care. If they go to work in a place that doesn't have a special ward as our hospital does, they have to know how to do chemotherapy. If they go to a small facility, they have to teach the nurses and other young doctors. It's not just theoretical knowledge that they bring, but practical knowledge of treating the disease."

Dr. Casanova has published extensively and has been recognized with the Hipolito Unanue Awards for his work in hepatocarcinoma. He and his team have received several honors, including the Roussell Award for their work in trophoblastic disease, Trifarma Laboratory's Scientific Award for their work with patients with solid tumors and short-term neutropenia, and Lemery Laboratories' Cancerology Award for their treatment of elderly patients with aggressive non-Hodgkin's lymphoma.

Marcia Landskroener for INCTR