This new book offers insights into where we are in curing cancer: The Death of Cancer: After 50 Years on the Front Lines of Medicine, a Pioneering Oncologist Reveals Why the War on Cancer is Winnable -- and What We Need to Do to Get There.
Clinical trials are designed to answer scientific questions about promising treatments that may prove to be ineffective and/or harmful. So a legitimate concern of patients is: “Can researchers really want what’s best for me?”
Two patients with the exact same tumor have different outcomes. Why?
Five hundred years ago, a 3-centimeter lump in one patient that looked and felt identical to that of another patient was considered the same tumor. Yet one patient did well and the other died.
With progress in science, doctors determined that tumors that look alike to the naked eye can look different under the microscope. Tumors were lumped together if they looked alike, felt the same, and had the same microscopic appearance. Yet still some patients did well while others died.
With progress in science, doctors determined that tumors that look alike under the microscope can have different surface proteins (antigens). Tumors were lumped together if they looked alike under the microscopic appearance and shared a specific array of surface antigens. Yet still some patients did well while others died.
This 3-minute video Gene Breakthroughs Spark a Revolution in Cancer Treatment explains how genetic markers are helping researchers separate seemingly identical tumors into those that might respond to a specific treatment and those expected not to respond.
It's a new way of thinking about cancer. What really matters? Where a cancer began? Or that it has genetic markers that indicate susceptibility to specific treatments?
If you remember only one thing from this post, may it be this: Well-funded and well-executed research is the only way to uncover truths about treating cancer.
An Oncology Times article caught my eye: "Relieving Major Depression in Cancer Patients: Specific 'Biopsychosocial' Method Found Useful." It reviewed a study that addressed the impact of an intervention developed to treat depression, reduce stress and help patients develop coping strategies.
Did you know that when you take a generic drug, you essentially forfeit the ability to sue the company making the drug for damages if you experience an adverse event?
The FDA revokes approval of Avastin for breast cancer. What's a survivor to do?
The case of the FDA revoking approval of Avastin for the treatment of breast cancer is complicated by the urgency of the need for better therapies. We’re not talking about treatments to decrease the sniffles of the common head cold. At issue is a drug to help patients who are suffering -- and dying -- from metastatic breast cancer.
Let's tease apart some of the sticky-wicket issues of FDA approvals and revocations. For one, how does the FDA measure success?
Now let's look at the players who influenced the FDA's decision to revoke approval of Avastin for breast cancer. The complex process requires a book-length manuscript to fully explain. Rather than abandon my effort, here are the bare bones:
To judge the FDA's recent revocation of approval for Avastin for breast cancer, let's go back to basics. What is the job of the FDA?
Recently the FDA revoked approval of a best-selling drug, Avastin, for treatment of breast cancer. Ever since, arguments for and against the removal have been voiced in blogs and major media by a wide variety of people with different points of view. Let's look at some of the issues in the context of Healthy Survivorship.
My recent posts have discussed some of the difficulties of modern medical decision-making in the context of PSA testing for prostate cancer. A new book by Harvard oncologist Jerome Groopman and Harvard endocrinologist Pamela Hartzband offers help to Healthy Survivors: Your Medical Mind: How to Decide What is Right for You.
Patients are not Healthy Survivors if they believe the promises of charlatans. What about patients who receive treatment from of team of professionals at a major university in a clinical trial that turns out to be based on wrong information?
In 2006, leaders in the state of Washington created the Health Technology Assessment (HTA) program to evaluate the cost-effectiveness of various medical therapies. With our country facing a huge budget deficit, what could be better than determining which treatments are worth paying for?
A NYTimes op-ed piece entitled A Fighting Spirit Won't Save Your Life concludes, "Linking health to personal virtue and vice not only is bad science, it’s bad medicine."
My recent posts are about the trouble of defining "rare cancers." The attention these cancers are now getting gives Healthy Survivors many reasons for hope.
My recent posts discuss the trouble with the adjective "rare" when talking about types of cancer. What's a researcher, clinician or patient to do?
Good news for Healthy Survivors! Now, along with ultra-strong hairsprays and ultra-rich ice-creams, we have:
I'm an outlier. Of all the patients diagnosed in 1990 with Stage III follicular lymphoma, I'm one of a small minority who are still kickin'. Why me?
Today I am not asking "What in the grand plan of the divine explains my extraordinary survivorship?" Rather, I'm asking "What is it about my physical body and/or my particular cancer that I've had a much-better-than-average response to the treatments?"
On my recent post about clinical trials, commenter Steve Walker wrote, "The Phase III trial is being run primarily to satisfy the rigid, formulaic and in many cases scientifically obsolete requirements imposed by the FDA's Office of Oncology Drug Products for most cancer drugs...."
Is the randomized clinical/controlled trial (RCT) obsolete?
Recently, I've pointed out the clashes between business and ethical considerations and beween clinicians' obligations to their individual patients and to the method that leads to advances. What if researchers can find ways to satisfy both the science and today's patients?
In Phase I trials researchers test an experimental treatment in a few patients for the first time. The purpose is NOT to see if the treatment kills cancer cells, but only to:
What if the patients in a Phase I trial experience shrinkage of their tumors? Should this speed up FDA approval of the trial drug?
My last post introduced a dilemma regarding modern clinical trials: Is it ethical to randomize some patients to the "control arm" of a trial where they will NOT receive the trial drug?
According a NYTimes article, one particular trial of a therapy (called PLX4032) for malignant melanoma "ignited an anguished debate among oncologists about whether a controlled trial that measures a drug's impact on extending life is still the best method for evaluating hundreds of genetically targeted cancer drugs being developed."
Sunday's NYTimes ran an article tackling a complex ethical dilemma in cancer care: The witholding of treatment in clinical trials. Because I was treated in 3 clinical trials in the 1990s, the topic is close to my heart.
People who hear my story often say, "You had an advantage getting into those clinical trials, because you were a doctor with connections." Given the paucity of patient-centered resources in 1993, this was true.
Today a plethora of excellent resources can help patients and families learn about clinical trials and find any available trials that might be right for you. Resources include:
As a scientist, I credit clinical trials with advancing our understanding of cancer and ability to treat it effectively. As a patient, I credit clinical trials with playing an essential role in my survival.
From both perspectives it troubles me greatly that only ~3% of adult cancer patients participate in clinical trials.
How can Healthy Survivors get good care -- the first criterion of Healthy Survivorship -- if the data needed to make sound choices in their particular situation is not yet available?
We need to revisit a prior post, so I can qualify what I said. On my June 22nd post, I mentioned the high incidence of changes in the carotid arteries in patients who received radiation years earlier. But I didn't provide any details.
Tags: late effects, post-treatment cardiovascular disease, premature carotid disease, radiation therapy and risk of stroke
Posted at 08:16 PM in Action, Clinical Trials, Dictionary of Healthy Survivorship, Doctor-Patient Communication, Happiness, Healthy Survivorship, Knowledge, Post-treatment Recovery, Science, Treatment Decisions, Uncertainty | Permalink | Comments (0) | TrackBack (0)
Tags: carotid disease, late effects, post-radiation
Many of my friends and family assume that the further away I get from the mini-mantle irradiation I received in 1992, the more I can relax about my developing any complications of that treatment. Not so.
What a three days I've had here at the 2010 Biennial Conference. While packing my suitcase for the return home, I'm thinking about all I've heard.
Posted at 09:19 AM in Action, Clinical Trials, Dictionary of Healthy Survivorship, Doctor-Patient Communication, End-of-Life, Family illness, Finances, Health care system, Healthy Survivorship, Hope, Knowledge, Post-treatment Recovery, Science, Uncertainty | Permalink | Comments (3) | TrackBack (0)
Tags: post-treatment survivorship
Tomorrow begins a conference entitled "Cancer Survivorship Research: Recovery and Beyond." And I have a job to do.
But then he explains that the new drug -- ipilimumab -- improves life expectancy from 6 months to 10 months. And it works well in only 20-30% of patients, the other 70-80% of patients showing no benefit at all. And it carries serious side effects, such as colitis and rheumatoid arthritis.
Is the fanfare hype? Are we celebrating too soon?
Your doctors evaluate your pain and conclude it is due to something benign (i.e., you don't have cancer, a broken bone or other health-threatening condition). Then they give you a prescription for a placebo. Should you sue these doctors? Or thank them?
Imagine being diagnosed with cancer and having your doctor recommend you not undergo treatment and, instead, "Watch and wait."
What? Do nothing but watch and worry?