Monthly Archives: October 2008

Treatment Side Effects May Predict Better Outcomes

No one likes the side effects of chemotherapy.  But would your attitude change if you knew that the side effects may predict success with your treatment for cancer?


 


A study in today’s issue of Lancet Oncology describes just such a finding in women with breast cancer treated with either tamoxifen or anastrozole as part of an adjuvant (preventive) treatment clinical trial. 


 


Women who participated in the trial had been diagnosed and treated for primary breast cancer.  In this study, the researchers examined the records of women who then received either anastrozole or tamoxifen to prevent the breast cancer from returning.


 


If a woman was treated with anastrozole or tamoxifen and developed vasomotor symptoms and/or joint pain after they started their medicine, then the chances that their breast cancer would return were lower than for a woman who did not develop either symptom.


 


The researchers can’t explain why this happened.  They suggested it may be related to a woman’s genetic profile and how her body processed the medications, but that isn’t for certain. 


 


The end result was that if a woman had vasomotor (usually called menopausal) symptoms, the chance that her … Continue reading →

Prostate Cancer: Selenium And Vitamin E Don’t Work

Just because it’s “natural” and looks like it might work to prevent cancer doesn’t mean it will work to prevent cancer.


 


That’s the message of today’s announcement from the National Cancer Institute and the Southwest Oncology Group (which is a national research group that does clinical trials in cancer) that they are telling the over 35,000 men participating in a prostate cancer prevention trial to stop taking their pills.


 


The study, called “SELECT” and which was started in 2001, was based on two earlier trials that found pretty much by accident that it appeared selenium and vitamin E decreased the incidence of prostate cancer. 


 


Both of those studies were designed to primarily look at cancers other than prostate cancer. One, in Finland, was done to see if vitamin E reduced lung cancer incidence and the other examined the impact of selenium on the incidence of skin cancer.  In both of the studies, there was tempting data that selenium or vitamin E unexpectedly reduced the risk of prostate cancer.


 


But those “accidental findings” didn’t hold up in a well-designed clinical trial.  Life is not always simple in medical research.


 


After 7 … Continue reading →

Social Security: A Big Step In The Right Direction

Maybe occasionally there is a glimmer of truth to the saying, “I’m from Washington and I’m here to help you.” 


 


Today, the Social Security Administration unveiled a new initiative to make it easier for people with certain serious medical conditions to get their Social Security disability benefits promptly and with a lot less hassle.


 


Called “The Compassionate Allowances Initiative,” this new program is due to the efforts of the Hon. Michael Astrue, the Commissioner of Social Security, and his staff to finally bring some streamlining to a process that has been frustratingly and agonizingly slow for so many patients and their families for so many for decades. 


  


The American Cancer Society was honored to participate in this effort through our testimony and subsequent support as this initiative moved through the Agency.  We thank the Agency for listening to patients, their families, the Society and others. 


 


Now we have a program to streamline and improve the process for determining Social Security benefits.  This is truly special for those with cancer who need help at the most difficult time of their lives.


 


What does this program offer?


 


For … Continue reading →

McCain’s Melanoma: A Different Look At The Numbers

Cancer and survivorship have played an unusually high-profile role in the current campaign for the Presidency.  Elizabeth Edwards and Rudy Giuliani come to mind.


 


Today, the Lancet—a well respected and authoritative British medical journal known among many for sometimes highlighting controversial topics to promote discussion—included a letter to the editor which concluded that Senator McCain had a 24% chance of surviving 10 years after his treatment for melanoma in 2000.


 


The author of the letter goes on to say that with regard to future risk, another data source suggested that the risk of dying from melanoma is constant over time, meaning that there is no expectation that the majority of deaths from melanoma occur shortly after the disease is diagnosed.  The author calculated that risk of death at essentially 12% per year for the foreseeable future of a McCain presidency. He then cut that to 6% given the Senator’s negative lymph node dissection.


 


The letter is short, the statistics complicated, and in my personal opinion, they lead the reader to an incorrect conclusion.


 


I have assiduously avoided getting involved in predicting the cancer outcome of the Presidential candidates, starting with some of the … Continue reading →

Targeting Colon Cancer Drugs: A Major Step Forward

Recently I wrote a blog about the effectiveness—or lack thereof–of some of the newer tests and treatments that are being marketed to cancer doctors and their patients.


 


An article in the current issue of the New England Journal, however, is a step in a better direction, namely a test that appears to help guide us to use our expensive (and effective) targeted therapies for patients who will benefit from them the most.


 


The test, which measures a change in a gene called K-ras in patients with colorectal cancer, appears to be able to predict which patients with advanced disease have the most chance of benefitting from a drug called cetuximab, which is commonly known as Erbitux.


 


In the clinical trial reported by researchers from Australia and Canada (and including authors from one of the drug companies that markets cetuximab), patients with advanced colorectal cancer who had failed standard chemotherapy for their disease and for whom no further treatments were available were randomly assigned to receive either cetuximab or no further treatment (best supportive care) for their disease. 


 


Those treated with cetuximab continued their medication until the cancer progressed or they could not tolerate … Continue reading →

Cancer Screening: The Data Doesn’t Tell The Story

Presidential elections aren’t the only things that interest pollsters. 


 


You may not know this, but periodic nationwide surveys done by respected government and private organizations have a substantial influence on how we assess the success of our health care system and how we direct our financial resources to address real or perceived problems.


 


But I have a longstanding bias that some of these surveys don’t reflect the state of affairs in the United States when it comes to accurately determining how many people in this country actually do what they tell the pollsters they do when it comes to cancer screening.


 


A research article in published in March 2008 in Oncology Nursing Forum, written by two of my colleagues at the American Cancer Society’s Behavioral Research Center confirms my suspicion: at least in a part of the African American community served by federally qualified community health centers, what the patients tell the pollsters doesn’t fit with what the medical records reveal.


 


The researchers interviewed African American women who attended these health centers, whose primary mission is to provide medical care to underserved populations. For the most part, the  women in this study were economically disadvantaged.


 Continue reading →

Does Red Wine Really Reduce Risk Of Lung Cancer?

Do you really believe that red wine—and only red wine among the alcoholic beverages—really reduces the risk of lung cancer?


 


Last week’s research report that smokers who drink red wine had a substantially decreased risk of developing lung cancer drew such a conclusion.  And the media climbed right on the bandwagon.


 


But I am not so certain that we can reasonably make that connection, and would suggest that until the data is replicated with an even larger study we should be cautious in suggesting that smokers should suddenly switch their adult beverage of choice to red wine from what I suspect is the more typical beer, bourbon and scotch.


 


The study as reported in the current issue of Cancer Epidemiology, Biomarkers and Prevention did say that their data showed “moderate red wine consumption” was related to a lower level risk for lung cancer.  Drink more red wine and you had a much lower incidence of lung cancer if you ever smoked cigarettes.  The same effects were not seen with other alcoholic beverages, including white wine.


 


I am not faulting the researchers for the work they did.  In fact, it was a … Continue reading →

Are We Overselling What We Know And What We Do?

We are now aware of where the excesses of the financial system have led us.  But I am also becoming increasingly concerned about excesses that I am seeing in claims regarding cancer research, diagnostics and treatment.


 


I have talked frequently about what I call the “hope and hype” cycle that was so prevalent when I started my oncology career back in the early 1970’s.  Lots of promises were made about miracles just around the corner, and unfortunately I was left to explain to patients and their families that these were more the fabric of dreams than based on solid expectations.


 


Fast forward to the past several years, and I have been unashamedly optimistic about where we are headed in cancer research and treatment.  We have made true progress, and the future from my vantage point is rich with potential, as we translate that progress into true advances which will reduce the burden and suffering from cancer.


 


I am now seeing situations where claims are being made that to me are reminiscent of that “hope and hype cycle” which was so prevalent back in the 1970’s and 80’s.


 


Last week’s blog on a genetically Continue reading →

Getting The Price Right On The Breast Test

I want to bring to your attention a correction which may be minor, but nonetheless important if you are considering getting the breast cancer genetic/prediction test discussed in my blog on October 8.


I noted in the blog that the cost of the test was $625.  My statement was based on a press release issued by the company.  I have the statement in my hand, and the price is clearly $625.


When the Washington Post reported on the test, it said the cost was $1,625.  Obviously, this is considerably greater than I wrote in my blog.


A loyal reader brought to my attention today that the link I provided in my blog to the company’s website says the cost is $1625.  


In any event, whether the price is $625 or $1,625, I can’t find many of my colleagues who think that it really has much value.  Not to mention their considerable concern about how the company has confused various types of risks regarding breast cancer, ending up with a number that my experts don’t think has value or meaning.


Bottom line, if you are considering getting this test, it is our recommendation that you be fully informed as to its value, whether that is the value … Continue reading →

Predicting Breast Cancer Risk Routinely: Not Yet

We are entering exciting times when it comes to the impact of genetics on the diagnosis and treatment of cancer. 


 


However, my colleagues’ discussions over the past 24 hours about a new test that claims to predict a woman’s risk of breast cancer have me thinking these exciting times may be more like the Old Wild West where “anything goes” than some meaningful movement forward in our battle against cancer.


 


The stated goal of the test is to enable a woman to predict her lifetime risk of getting cancer.  The accompanying material from the company liberally quotes the American Cancer Society and the American Society of Clinical Oncology as references to support the value of the test.


 


The company says that this test—which is an analysis of genetic code obtained from cells that are either swabbed from the mouth or taken with a blood sample and then analyzed in the company’s laboratory—measures seven genetic changes that “contribute to the incidence of an estimated 60 per cent of all breast cancer cases.”


 


The test is based on “studies published in major peer-reviewed journals and involving nearly 100,000 breast cancer patients and healthy volunteers, principally of … Continue reading →